Healthcare Provider Details

I. General information

NPI: 1952096026
Provider Name (Legal Business Name): TRACY OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 SHELDON DR
MONTICELLO NY
12701-4122
US

IV. Provider business mailing address

41 SHELDON DR
MONTICELLO NY
12701-4122
US

V. Phone/Fax

Practice location:
  • Phone: 845-513-5754
  • Fax: 914-292-3422
Mailing address:
  • Phone: 845-513-5754
  • Fax: 914-292-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: