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General NPI Number Information
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NPI Number | 1093337651
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Entity Type | Individual
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Provider Name | MR. SULLAVAN O'HARA
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Gender | Male
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Dates
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Enumeration Date | 05/17/2020
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Last Update Date | 05/17/2020
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Provider Practice Location Address
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Address Line | 3 HOSPITAL DR
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City | COLUMBIA
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State | MO
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Zip | 65201-5276
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Country | US
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Telephone | 573-884-1255
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Fax | 573-884-1010
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Provider Business Mailing Address
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Address Line | 816 S CENTRAL ST
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City | CENTRALIA
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State | MO
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Zip | 65240-1810
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Country | US
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Telephone | 816-786-0609
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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