Healthcare Provider Details

I. General information

NPI: 1679357859
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER O'HARE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3399 WINTON RD S
ROCHESTER NY
14623-3057
US

IV. Provider business mailing address

3399 WINTON RD S
ROCHESTER NY
14623-3057
US

V. Phone/Fax

Practice location:
  • Phone: 585-334-6000
  • Fax: 585-334-2858
Mailing address:
  • Phone: 585-334-6000
  • Fax: 585-334-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number028208
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: