Provider Demographics
NPI:1154753580
Name:OHARA, ALLIE (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ALLIE
Middle Name:
Last Name:OHARA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8506 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1916
Mailing Address - Country:US
Mailing Address - Phone:918-357-6209
Mailing Address - Fax:
Practice Address - Street 1:8506 E 61ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1916
Practice Address - Country:US
Practice Address - Phone:918-357-6209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAJ017438235Z00000X
OK4334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist