Provider Demographics
NPI:1407626013
Name:O'ROURKE, MICHAEL (237700000X)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:M
Credentials:237700000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 WATERMAN BLVD STE A3
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1869
Mailing Address - Country:US
Mailing Address - Phone:707-422-6260
Mailing Address - Fax:
Practice Address - Street 1:2401 WATERMAN BLVD STE A3
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1869
Practice Address - Country:US
Practice Address - Phone:707-422-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist