MEDICARE: LAURA V OBRIEN OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1093094450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA V OBRIEN OTR/L

Provider Business Mailing Address
First Line	:	36 MAIN ST
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-4059
Country	:	US
Telephone Number	:	847-692-6692
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 MAIN ST
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-4059
Country	:	US
Telephone Number	:	847-692-6692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	07/21/2022

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Directions to “ LAURA V OBRIEN OTR/L” Practice Location

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