Provider Demographics
NPI:1093580474
Name:HENRY, MALORI (CMT NCTMB)
Entity Type:Individual
Prefix:
First Name:MALORI
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:CMT NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-1701
Mailing Address - Country:US
Mailing Address - Phone:785-294-2725
Mailing Address - Fax:
Practice Address - Street 1:115 W 4TH ST
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-1701
Practice Address - Country:US
Practice Address - Phone:785-294-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist