Provider Demographics
NPI:1013050012
Name:O'LAREY, MICHAEL J (ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:O'LAREY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 LAMANITE CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7919
Mailing Address - Country:US
Mailing Address - Phone:505-646-1526
Mailing Address - Fax:505-646-3435
Practice Address - Street 1:MSC 3FAC NEW MEXICO STATE UNIVERSITY
Practice Address - Street 2:P P BOX 30001
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003-8001
Practice Address - Country:US
Practice Address - Phone:505-646-1526
Practice Address - Fax:505-646-3435
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer