Individual
MISS WANDA LEE WILLOW O'ROURKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, MMP
Contact information
Practice address
1811 RIDGECREST DR SE, ALBUQUERQUE, NM 87108-4527
(505) 261-0540
Mailing address
1811 RIDGECREST DR SE, ALBUQUERQUE, NM 87108-4527
(505) 261-0540
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
5421
NM
Other
Enumeration date
06/10/2009
Last updated
06/10/2009
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