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General NPI Number Information
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NPI Number | 1639809965
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Entity Type | Organization
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Legal Business Name | THE BAREFOOT LOTUS LLC
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 706 SW A AVE STE A
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City | LAWTON
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State | OK
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Zip | 73501-3932
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Country | US
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Telephone | 580-917-6153
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Fax |
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Provider Business Mailing Address
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Address Line | 621 SE 38TH ST
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City | LAWTON
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State | OK
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Zip | 73501-8401
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Country | US
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Telephone | 580-917-6153
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. JOANN OMENGEBAR
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Credential | HHP
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Telephone | 580-917-6153
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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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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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