Provider Demographics
NPI:1619305802
Name:O'HARA, INGRID R (MS, PT)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:R
Last Name:O'HARA
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SAMOS LN
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2820
Mailing Address - Country:US
Mailing Address - Phone:978-749-3152
Mailing Address - Fax:
Practice Address - Street 1:80 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-5606
Practice Address - Country:US
Practice Address - Phone:978-289-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist