Healthcare Provider Details

I. General information

NPI: 1194629923
Provider Name (Legal Business Name): KELSEY DANIELLE OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5504 PINEBROOK RD
NOKOMIS FL
34275-3672
US

IV. Provider business mailing address

16 CORALBERRY LN
GLASTONBURY CT
06033-1219
US

V. Phone/Fax

Practice location:
  • Phone: 941-919-3841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT27472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: