1265972590 NPI number — JESSICA O'HARA ALLEN DPT

Table of content: JESSICA O'HARA ALLEN DPT (NPI 1265972590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265972590 NPI number — JESSICA O'HARA ALLEN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'HARA ALLEN
Provider First Name:
JESSICA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'HARA
Provider Other First Name:
JESSICA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265972590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 CORPORATE DR STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-5424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-682-8840
Provider Business Mailing Address Fax Number:
423-602-2028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6250 COMMERCIAL ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97306-2988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-485-1666
Provider Business Practice Location Address Fax Number:
503-581-6867
Provider Enumeration Date:
03/06/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)