Provider Demographics
NPI:1689016537
Name:O'REA, EDWARD ISSAC
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ISSAC
Last Name:O'REA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 SKY POINTE DR APT 2129
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-4967
Mailing Address - Country:US
Mailing Address - Phone:702-348-1429
Mailing Address - Fax:
Practice Address - Street 1:5850 SKY POINTE DR APT 2129
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-4967
Practice Address - Country:US
Practice Address - Phone:702-348-1429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner