Healthcare Provider Details

I. General information

NPI: 1922141720
Provider Name (Legal Business Name): PAMELA O'BRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 OYSTER BAY RD
EAST NORWICH NY
11732-1051
US

IV. Provider business mailing address

107 FLORENCE DR
SYOSSET NY
11791-4819
US

V. Phone/Fax

Practice location:
  • Phone: 516-677-1994
  • Fax:
Mailing address:
  • Phone: 516-662-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number010719-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: