Basic Information
| Provider Information | |||||||||
| NPI: | 1962934349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'HARA | ||||||||
| FirstName: | DEVIN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 NORWOOD RD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253141327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045614016 | ||||||||
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| Practice Location | |||||||||
| Address1: | 182 E REDSTONE AVE STE A | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325395371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8555277246 | ||||||||
| FaxNumber: | 8662295063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2017 | ||||||||
| LastUpdateDate: | 09/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | DO2616 | AL | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208100000X | OS18028 | FL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.