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NPI Code Detail

MEDICARE: MRS. DOLORES O'BRIEN MS CCC-SP

MEDICARE: MRS. DOLORES O'BRIEN MS CCC-SP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist005737NY

General Provider Information

NPI Number : 1548530876
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DOLORES O'BRIEN MS CCC-SP
Provider Business Mailing Address
First Line : 19 DIDIO LN
Second Line :
City : MONTGOMERY
State : NY
Zip : 12549-2713
Country : US
Telephone Number : 845-567-8390
Fax Number :
Provider Business Practice Location Address
First Line : 946 STATE ROUTE 17K
Second Line :
City : MONTGOMERY
State : NY
Zip : 12549-2213
Country : US
Telephone Number : 845-457-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2012
Last Update Date : 01/03/2012

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