Provider Demographics
NPI:1770973265
Name:O'LEARY, MICHAEL T
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:O'LEARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:O'LEARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OWNER
Mailing Address - Street 1:906 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-3210
Mailing Address - Country:US
Mailing Address - Phone:806-331-1618
Mailing Address - Fax:800-291-4713
Practice Address - Street 1:1900 INDUSTRIAL BLVD STE 208
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5797
Practice Address - Country:US
Practice Address - Phone:682-223-1628
Practice Address - Fax:877-328-9182
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator