Individual
MS. TRACI MARIE O'HARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T.
Contact information
Practice address
104 CHESTNUT ST, RIDGEWOOD, NJ 07450-2502
(201) 493-8111
Mailing address
104 CHESTNUT ST, RIDGEWOOD, NJ 07450-2502
(201) 493-8111
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
40QA00975000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067570
MEDICARE PEOVIDER#
NJ
Enumeration date
09/12/2007
Last updated
09/12/2007
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