Provider Demographics
NPI:1003009044
Name:OHAVER, PATRICK MICHAEL (ATC)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:OHAVER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2915
Mailing Address - Country:US
Mailing Address - Phone:219-836-4163
Mailing Address - Fax:
Practice Address - Street 1:1950 45TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3917
Practice Address - Country:US
Practice Address - Phone:219-922-8188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001384A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer