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General NPI Number Information
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NPI Number | 1659896595
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Entity Type | Individual
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Provider Name | WILLIAM SEAN O'MALLEY LMT
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Gender | Male
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Dates
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Enumeration Date | 08/11/2017
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Last Update Date | 08/11/2017
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Provider Practice Location Address
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Address Line | 7200 E DRY CREEK RD STE C103
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City | CENTENNIAL
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State | CO
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Zip | 80112-2562
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Country | US
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Telephone | 303-566-0999
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Fax |
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Provider Business Mailing Address
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Address Line | 8195 S NEWPORT WAY
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City | CENTENNIAL
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State | CO
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Zip | 80112-3105
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Country | US
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Telephone | 303-525-9706
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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 | 1140
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License Number State | CO
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