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General NPI Number Information
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NPI Number | 1174813992
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Entity Type | Individual
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Provider Name | BABARA JEAN ODMAN MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 7424 E POINT DOUGLAS RD S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-3025
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Country | US
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Telephone | 651-398-2869
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Fax |
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Provider Business Mailing Address
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Address Line | 213 SIBLEY ST #106
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City | HASTINGS
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State | MN
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Zip | 55033-1252
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Country | US
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Telephone | 651-398-2869
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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