Provider Demographics
NPI:1063658748
Name:O'BRION, KRISTINE ANN (CREDIFIED MASSAGE TH)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANN
Last Name:O'BRION
Suffix:
Gender:F
Credentials:CREDIFIED MASSAGE TH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16724 BRUNSWICK AVE SE APT 104
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-3989
Mailing Address - Country:US
Mailing Address - Phone:612-751-1925
Mailing Address - Fax:
Practice Address - Street 1:16724 BRUNSWICK AVE SE APT 104
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-3989
Practice Address - Country:US
Practice Address - Phone:612-751-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor