MEDICARE: KEVIN O'HARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41YS00228500	NJ

General Provider Information

NPI Number	:	1801036553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN O'HARE

Provider Business Mailing Address
First Line	:	2 MAIN ST.,, SUITE 3
Second Line	:	SPEECH AT THE BEACH
City	:	BRADLEY BEACH
State	:	NJ
Zip	:	07720-1062
Country	:	US
Telephone Number	:	732-455-5504
Fax Number	:	732-455-5505

Provider Business Practice Location Address
First Line	:	2 MAIN ST
Second Line	:	SUITE 3
City	:	BRADLEY BEACH
State	:	NJ
Zip	:	07720-1059
Country	:	US
Telephone Number	:	732-455-5504
Fax Number	:	732-455-5505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	02/01/2012

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Directions to “ KEVIN O'HARE ” Practice Location

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