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General NPI Number Information
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NPI Number | 1366521684
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Entity Type | Individual
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Provider Name | KATHLEEN ANN O'LEARY M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 164 WACCAMAW MEDICAL PARK DR
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City | CONWAY
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State | SC
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Zip | 29526-8903
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Country | US
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Telephone | 843-347-5060
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Fax |
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Provider Business Mailing Address
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Address Line | 525 LAFAYETTE CIR
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City | GEORGETOWN
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State | SC
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Zip | 29440-2569
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Country | US
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Telephone | 843-546-6107
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 055412
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 24236
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License Number State | SC
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