Provider Demographics
NPI:1639909195
Name:O'HANNON, LATORIA MICHELLE
Entity type:Individual
Prefix:
First Name:LATORIA
Middle Name:MICHELLE
Last Name:O'HANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 ROTHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-4819
Mailing Address - Country:US
Mailing Address - Phone:267-297-9013
Mailing Address - Fax:
Practice Address - Street 1:1000 N YORK RD STE 1
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1326
Practice Address - Country:US
Practice Address - Phone:121-552-8449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies