Healthcare Provider Details

I. General information

NPI: 1942283916
Provider Name (Legal Business Name): TERRY L. O'BRIEN ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TOWSON UNIVERSITY - ATHLETICS SPORTS MEDICINE 8000 YORK RD. FIELD HOUSE 101
TOWSON MD
21252-0001
US

IV. Provider business mailing address

40 SUGAR TREE PL
COCKEYSVILLE MD
21030-3185
US

V. Phone/Fax

Practice location:
  • Phone: 410-704-3606
  • Fax: 410-704-2727
Mailing address:
  • Phone: 410-667-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: