Healthcare Provider Details

I. General information

NPI: 1235910456
Provider Name (Legal Business Name): VANESSA OBREY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 FAR CORNERS LOOP
SPARKS MD
21152-9257
US

IV. Provider business mailing address

16 FAR CORNERS LOOP
SPARKS MD
21152-9257
US

V. Phone/Fax

Practice location:
  • Phone: 410-905-3103
  • Fax:
Mailing address:
  • Phone: 410-905-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMO4897
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: