Provider Demographics
NPI:1730964875
Name:GENESIS ORAL MYOFUNCTIONAL THERAPY
Entity type:Organization
Organization Name:GENESIS ORAL MYOFUNCTIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OMT
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBIECK
Authorized Official - Suffix:
Authorized Official - Credentials:RDH OMT
Authorized Official - Phone:208-691-0676
Mailing Address - Street 1:6327 S ZEPHYR CT
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3568
Mailing Address - Country:US
Mailing Address - Phone:208-691-0676
Mailing Address - Fax:
Practice Address - Street 1:6327 S ZEPHYR CT
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3568
Practice Address - Country:US
Practice Address - Phone:208-691-0676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty