Healthcare Provider Details

I. General information

NPI: 1447334016
Provider Name (Legal Business Name): CINDY MICHELLE O'ROURKE M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N MARKET ST
GALLATIN MO
64640-1156
US

IV. Provider business mailing address

122 N MARKET ST
GALLATIN MO
64640-1156
US

V. Phone/Fax

Practice location:
  • Phone: 660-663-2101
  • Fax: 660-663-2150
Mailing address:
  • Phone: 660-663-2101
  • Fax: 660-663-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2004002405
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: