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General NPI Number Information
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NPI Number | 1770973265
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Entity Type | Individual
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Provider Name | MICHAEL T O'LEARY
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Gender | Male
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Dates
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Enumeration Date | 02/04/2015
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 1900 INDUSTRIAL BLVD STE 208
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City | COLLEYVILLE
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State | TX
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Zip | 76034-5797
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Country | US
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Telephone | 682-223-1628
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Fax | 877-328-9182
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Provider Business Mailing Address
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Address Line | 906 S JEFFERSON ST
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City | AMARILLO
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State | TX
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Zip | 79101-3210
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Country | US
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Telephone | 806-331-1618
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Fax | 800-291-4713
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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