Healthcare Provider Details

I. General information

NPI: 1821219973
Provider Name (Legal Business Name): MICHAEL DENNIS O'HARA LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 MOUNT HOOD AVE
WOODBURN OR
97071-9066
US

IV. Provider business mailing address

2833 HOOVER AVE NW
SALEM OR
97304-3789
US

V. Phone/Fax

Practice location:
  • Phone: 971-983-5250
  • Fax: 971-983-5253
Mailing address:
  • Phone: 503-409-3848
  • Fax: 971-983-5253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11989
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: