Provider Demographics
NPI:1902210339
Name:MAHAR, KEIRA
Entity Type:Individual
Prefix:MRS
First Name:KEIRA
Middle Name:
Last Name:MAHAR
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 1:289 PENHURST RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2751
Mailing Address - Country:US
Mailing Address - Phone:585-755-1283
Mailing Address - Fax:
Practice Address - Street 1:295 MARY JEMISON DR
Practice Address - Street 2:OPWDD - DOTY DAY SERVICES
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1285
Practice Address - Country:US
Practice Address - Phone:585-243-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020669235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist