Provider Demographics
NPI:1972994945
Name:O'HEIR, KATHRYN ELIZABETH (MSLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:O'HEIR
Suffix:
Gender:F
Credentials:MSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1486B BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2602
Mailing Address - Country:US
Mailing Address - Phone:207-245-4445
Mailing Address - Fax:
Practice Address - Street 1:72 OCEAN ST
Practice Address - Street 2:UNIT 309
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2840
Practice Address - Country:US
Practice Address - Phone:207-245-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2377235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist