Healthcare Provider Details

I. General information

NPI: 1376834952
Provider Name (Legal Business Name): PATRICIA LEARY OBRIEN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LINDSLEY DR SUITE 207
MORRISTOWN NJ
07960-4455
US

IV. Provider business mailing address

25 LINDSLEY DR SUITE 207
MORRISTOWN NJ
07960-4455
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-0770
  • Fax:
Mailing address:
  • Phone: 973-971-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR0019200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR000086100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: