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General NPI Number Information
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NPI Number | 1457433294
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Entity Type | Individual
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Provider Name | CHRISTOPHER WILLIAM O'BRIEN PHD, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | KING'S COLLEGE 133 NORTH RIVER STREET
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City | WILKES-BARRE
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State | PA
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Zip | 18711
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Country | US
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Telephone | 570-208-8404
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Fax |
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Provider Business Mailing Address
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Address Line | 627 MARY JO DR
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City | JESSUP
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State | PA
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Zip | 18434-1965
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Country | US
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Telephone | 570-430-9225
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001603-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT001243A
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License Number State | PA
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