Healthcare Provider Details

I. General information

NPI: 1306095856
Provider Name (Legal Business Name): AMY CIESYNSKI O'BRIEN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HIGH ST
WAKEFIELD RI
02879
US

IV. Provider business mailing address

10 HIGH ST
WAKEFIELD RI
02879-3176
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-8077
  • Fax: 401-789-6029
Mailing address:
  • Phone: 401-783-8077
  • Fax: 401-789-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT01172
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT01172
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: