Provider Demographics
NPI:1508571506
Name:O'HARA, CRYSTAL RUTH (MSA)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:RUTH
Last Name:O'HARA
Suffix:
Gender:F
Credentials:MSA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:RUTH
Other - Last Name:STYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1693 COUNTY ROUTE 41
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-2141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:159 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2045
Practice Address - Country:US
Practice Address - Phone:315-342-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1114966174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist