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General NPI Number Information
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NPI Number | 1942525647
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Entity Type | Individual
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Provider Name | HEATHER M O'HARA M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/06/2010
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 2120 N 27TH ST
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City | DECATUR
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State | IL
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Zip | 62526-2191
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Country | US
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Telephone | 217-876-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 N 27TH ST
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City | DECATUR
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State | IL
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Zip | 62526-2191
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Country | US
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Telephone | 217-876-4600
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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 | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 46544
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 036151729
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License Number State | IL
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