Provider Demographics
NPI:1538377882
Name:O'HARA, MICHAEL KEVIN
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KEVIN
Last Name:O'HARA
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 1:212 S MAIN ST
Mailing Address - Street 2:P.O. BOX 64
Mailing Address - City:SUGAR GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:43155-0064
Mailing Address - Country:US
Mailing Address - Phone:740-503-5637
Mailing Address - Fax:
Practice Address - Street 1:1813 BALTIMORE RD NW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8212
Practice Address - Country:US
Practice Address - Phone:740-681-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2710098Medicaid