Healthcare Provider Details

I. General information

NPI: 1952378390
Provider Name (Legal Business Name): MAUREEN O'BRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 RIDGEWOOD DR
WYNANTSKILL NY
12198-2824
US

IV. Provider business mailing address

PO BOX 387 43 MALL
WEST SAND LAKE NY
12196-0387
US

V. Phone/Fax

Practice location:
  • Phone: 518-674-1744
  • Fax:
Mailing address:
  • Phone: 518-283-7374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0138581
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: