Provider Demographics
NPI:1568549079
Name:O'HARE, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:O'HARE
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 1:14504 GREENVIEW DR STE 106
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-4224
Mailing Address - Country:US
Mailing Address - Phone:301-776-3665
Mailing Address - Fax:301-776-6669
Practice Address - Street 1:14504 GREENVIEW DR STE 106
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-4224
Practice Address - Country:US
Practice Address - Phone:301-776-3665
Practice Address - Fax:301-776-6669
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P99462Medicare UPIN
MD012615M87Medicare ID - Type Unspecified