1508816711 NPI number — MRS. CHARLENE L O GARA-MOE SPEECH PATHOLOGIST

Table of content: MRS. CHARLENE L O GARA-MOE SPEECH PATHOLOGIST (NPI 1508816711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508816711 NPI number — MRS. CHARLENE L O GARA-MOE SPEECH PATHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O GARA-MOE
Provider First Name:
CHARLENE
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SPEECH PATHOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508816711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
726 SPRING CREEK PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING CREEK
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-753-6806
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 BLUFFS AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ELKO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-738-2925
Provider Business Practice Location Address Fax Number:
775-738-7395
Provider Enumeration Date:
05/10/2006

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: 235Z00000X , with the licence number:  SP1069 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com