Provider Demographics
NPI:1295566875
Name:OMAR, ESRAA (HIS)
Entity type:Individual
Prefix:
First Name:ESRAA
Middle Name:
Last Name:OMAR
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 S PROGRESS DR STE B
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2672
Mailing Address - Country:US
Mailing Address - Phone:937-971-4524
Mailing Address - Fax:937-376-0645
Practice Address - Street 1:156 S PROGRESS DR STE B
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2672
Practice Address - Country:US
Practice Address - Phone:937-971-4524
Practice Address - Fax:937-376-0645
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIL.03512237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist