Provider Demographics
NPI:1154723641
Name:THOMAS O'HARA II LLC
Entity type:Organization
Organization Name:THOMAS O'HARA II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:O'HARA
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:505-801-7795
Mailing Address - Street 1:1020 E GROVE ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-3184
Mailing Address - Country:US
Mailing Address - Phone:505-801-7795
Mailing Address - Fax:
Practice Address - Street 1:1020 E GROVE ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-3184
Practice Address - Country:US
Practice Address - Phone:505-801-7795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA90742355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty