Healthcare Provider Details

I. General information

NPI: 1942525647
Provider Name (Legal Business Name): HEATHER M O'HARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 N 27TH ST
DECATUR IL
62526-2191
US

IV. Provider business mailing address

2120 N 27TH ST
DECATUR IL
62526-2191
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-4600
  • Fax:
Mailing address:
  • Phone: 217-876-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number46544
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number036151729
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: