Healthcare Provider Details

I. General information

NPI: 1003995481
Provider Name (Legal Business Name): SCOTT JOSEPH O'LEARY M.S., CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 OAKBEND TRL STE 260
FORT WORTH TX
76132-3923
US

IV. Provider business mailing address

P.O. BOX 961205
FORT WORTH TX
76161-1205
US

V. Phone/Fax

Practice location:
  • Phone: 817-346-6000
  • Fax: 817-346-6009
Mailing address:
  • Phone: 817-740-8400
  • Fax: 817-378-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51096
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: