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General NPI Number Information
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NPI Number | 1760781884
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Entity Type | Individual
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Provider Name | COLEEN M O'CONNOR CMT
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Gender | Female
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 6-16 E BLACKWELL ST
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City | DOVER
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State | NJ
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Zip | 07801-4664
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Country | US
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Telephone | 201-400-0219
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Fax |
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Provider Business Mailing Address
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Address Line | 10 BALCHEN WAY
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City | ROCKAWAY
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State | NJ
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Zip | 07866-4702
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Country | US
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Telephone | 201-400-0219
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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 | 26BT00224700
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License Number State | NJ
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