Provider Demographics
NPI:1700101094
Name:O'MEARA, JACQUELINE (AP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:O'MEARA
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LAKESHORE DR
Mailing Address - Street 2:PH31
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3607
Mailing Address - Country:US
Mailing Address - Phone:561-429-6155
Mailing Address - Fax:
Practice Address - Street 1:1216 US HIGHWAY 1
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3537
Practice Address - Country:US
Practice Address - Phone:561-628-8701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2670171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist