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General NPI Number Information
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NPI Number | 1427370725
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Entity Type | Individual
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Provider Name | JESSICA RENEE O'MALLEY LAC., LMP, AWC
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Gender | Female
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Dates
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Enumeration Date | 02/27/2010
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Last Update Date | 02/27/2010
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Provider Practice Location Address
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Address Line | 113 5TH AVE SE
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City | OLYMPIA
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State | WA
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Zip | 98501-1121
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Country | US
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Telephone | 360-357-9470
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Fax |
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Provider Business Mailing Address
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Address Line | 11014 CHARM RD SE
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City | RAINIER
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State | WA
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Zip | 98576-9703
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Country | US
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Telephone | 617-797-4652
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC60103301
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License Number State | WA
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