Provider Demographics
NPI:1639809965
Name:THE BAREFOOT LOTUS LLC
Entity Type:Organization
Organization Name:THE BAREFOOT LOTUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:OMENGEBAR
Authorized Official - Suffix:
Authorized Official - Credentials:HHP
Authorized Official - Phone:580-917-6153
Mailing Address - Street 1:621 SE 38TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-8401
Mailing Address - Country:US
Mailing Address - Phone:580-917-6153
Mailing Address - Fax:
Practice Address - Street 1:706 SW A AVE STE A
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3932
Practice Address - Country:US
Practice Address - Phone:580-917-6153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty