Provider Demographics
NPI:1801420062
Name:OHARA, KEELAN SIOBHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KEELAN
Middle Name:SIOBHAN
Last Name:OHARA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8205 W WARM SPRINGS RD STE 250
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3646
Mailing Address - Country:US
Mailing Address - Phone:702-294-7498
Mailing Address - Fax:702-252-0369
Practice Address - Street 1:8205 W WARM SPRINGS RD STE 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3646
Practice Address - Country:US
Practice Address - Phone:702-294-7498
Practice Address - Fax:702-252-0369
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4205OtherLICENSE