Healthcare Provider Details

I. General information

NPI: 1275448433
Provider Name (Legal Business Name): KATHLEEN GANNON MAOM, DAOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 W. US HWY 290 SERVICE RD STE #106
AUSTIN TX
78735
US

IV. Provider business mailing address

5424 W. US HWY 290 SERVICE RD STE #106
AUSTIN TX
78735
US

V. Phone/Fax

Practice location:
  • Phone: 512-387-4002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: