Doctor Name: | PENELOPE O'BRIEN |
NPI Number: | 1053490136 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | MA00015494 |
Business Practice Address: | 1405 E Edison Ave Sunnyside, WA - 989441622 |
Business Phone Number: | 5098377400 |
Business Fax Number: | 5098375068 |
Mailing Address: | Po Box 307, BOUNTIFUL |
State: | UT |
Postal Code: | 840110307 |
Phone Number: | 8887006907 |
Fax Number: | 8012946917 |
NPI Enumeration Date: | 11/02/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA00015494 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |