| Doctor Name: | KELLY MAUREEN O'LEARY |
| NPI Number: | 1912131921 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA60082168 |
| Business Practice Address: | 3920 W Tapps Dr E Lake Tapps, WA - 983919176 |
| Business Phone Number: | 2538628001 |
| Business Fax Number: | 2538264792 |
| Mailing Address: | 3920 W Tapps Dr E, LAKE TAPPS |
| State: | WA |
| Postal Code: | 983919176 |
| Phone Number: | 2538628001 |
| Fax Number: | 2538264792 |
| NPI Enumeration Date: | 05/05/2009 |
| NPI Last Update Date: | 05/05/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA60082168 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |