Provider Demographics
NPI:1649073180
Name:O'BRIEN, KATHLEEN ISABEL (LMT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ISABEL
Last Name:O'BRIEN
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SE 2ND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6850
Mailing Address - Country:US
Mailing Address - Phone:772-284-5132
Mailing Address - Fax:
Practice Address - Street 1:405 SE 2ND AVE STE 1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6850
Practice Address - Country:US
Practice Address - Phone:772-284-5132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA88554225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist