Healthcare Provider Details

I. General information

NPI: 1821797937
Provider Name (Legal Business Name): CARRIE OHARA MT23007
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 21ST ST SE STE 9
RIO RANCHO NM
87124-4030
US

IV. Provider business mailing address

1005 21ST ST SE STE 9
RIO RANCHO NM
87124-4030
US

V. Phone/Fax

Practice location:
  • Phone: 505-239-9644
  • Fax: 505-896-2958
Mailing address:
  • Phone: 505-239-9644
  • Fax: 505-896-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT23007
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: