Provider Demographics
NPI:1124743760
Name:O'HEARN, TERRY A
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:A
Last Name:O'HEARN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TERRY
Other - Middle Name:A
Other - Last Name:KEATING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1623 S SPRUCE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601
Mailing Address - Country:US
Mailing Address - Phone:307-439-9856
Mailing Address - Fax:
Practice Address - Street 1:1623 S SPRUCE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-439-9856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services