Provider Demographics
NPI:1952501074
Name:O'LEARY, RAE ALISON (RRT)
Entity Type:Individual
Prefix:MS
First Name:RAE
Middle Name:ALISON
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 64 BOX 52
Mailing Address - Street 2:
Mailing Address - City:TIMBER LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57656-9740
Mailing Address - Country:US
Mailing Address - Phone:605-964-3418
Mailing Address - Fax:605-964-3415
Practice Address - Street 1:HC 64 BOX 52
Practice Address - Street 2:
Practice Address - City:TIMBER LAKE
Practice Address - State:SD
Practice Address - Zip Code:57656-9740
Practice Address - Country:US
Practice Address - Phone:605-964-3418
Practice Address - Fax:605-964-3415
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD93588227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDPENDINGMedicaid