Individual
KELLY O'HARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 266-1000
Mailing address
8045 ORIOLE AVE APT 21-101, FORT WAYNE, IN 46804-0015
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37002774A
IN
Other
Enumeration date
05/22/2017
Last updated
05/22/2017
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