Provider Demographics
NPI:1174062541
Name:O'HARA, KATHLEEN MARY (MA,CCC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:O'HARA
Suffix:
Gender:F
Credentials:MA,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BROADWAY
Mailing Address - Street 2:16A
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2138
Mailing Address - Country:US
Mailing Address - Phone:914-693-8401
Mailing Address - Fax:
Practice Address - Street 1:300 BROADWAY
Practice Address - Street 2:16A
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2138
Practice Address - Country:US
Practice Address - Phone:914-693-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-18
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007996-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist