Provider Demographics
NPI:1083385264
Name:O'HARA, KATHLEEN EMILIE
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:EMILIE
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 1:515 BREMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MATTYDALE
Mailing Address - State:NY
Mailing Address - Zip Code:13211-1229
Mailing Address - Country:US
Mailing Address - Phone:315-454-3012
Mailing Address - Fax:
Practice Address - Street 1:515 BREMAN AVE
Practice Address - Street 2:
Practice Address - City:MATTYDALE
Practice Address - State:NY
Practice Address - Zip Code:13211-1229
Practice Address - Country:US
Practice Address - Phone:315-454-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider