Healthcare Provider Details

I. General information

NPI: 1700792694
Provider Name (Legal Business Name): JOANN OMENGEBAR LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 SW 3RD ST
LAWTON OK
73501-4055
US

IV. Provider business mailing address

809 SE CABER CIR
LAWTON OK
73501-6603
US

V. Phone/Fax

Practice location:
  • Phone: 580-917-6153
  • Fax:
Mailing address:
  • Phone: 580-917-6153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10034
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: