Provider Demographics
NPI:1801036553
Name:O'HARE, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:O'HARE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MAIN ST.,, SUITE 3
Mailing Address - Street 2:SPEECH AT THE BEACH
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720-1062
Mailing Address - Country:US
Mailing Address - Phone:732-455-5504
Mailing Address - Fax:732-455-5505
Practice Address - Street 1:2 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BRADLEY BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07720-1059
Practice Address - Country:US
Practice Address - Phone:732-455-5504
Practice Address - Fax:732-455-5505
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00228500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist