Provider Demographics
NPI:1003928920
Name:O'HARA, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:O'HARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3586 S DEPEW ST UNIT 306
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2808
Mailing Address - Country:US
Mailing Address - Phone:720-938-4104
Mailing Address - Fax:
Practice Address - Street 1:155 W HAMPDEN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2400
Practice Address - Country:US
Practice Address - Phone:303-789-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTAOtherLICENSE#