Provider Demographics
NPI:1831849017
Name:O'HARE, ROISIN (LMT)
Entity type:Individual
Prefix:MRS
First Name:ROISIN
Middle Name:
Last Name:O'HARE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12093-0035
Mailing Address - Country:US
Mailing Address - Phone:646-247-0319
Mailing Address - Fax:
Practice Address - Street 1:31 HARPER ST STE 2
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:NY
Practice Address - Zip Code:12167-1041
Practice Address - Country:US
Practice Address - Phone:607-652-2852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032877225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty