Provider Demographics
NPI:1912583493
Name:O'ROURKE, CHRISTEL LEONA (CMT)
Entity Type:Individual
Prefix:
First Name:CHRISTEL
Middle Name:LEONA
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:AVILA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93424-0295
Mailing Address - Country:US
Mailing Address - Phone:805-440-2467
Mailing Address - Fax:
Practice Address - Street 1:310 FRONT ST STE B&C
Practice Address - Street 2:
Practice Address - City:AVILA BEACH
Practice Address - State:CA
Practice Address - Zip Code:93424-3552
Practice Address - Country:US
Practice Address - Phone:805-440-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83542225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist