MEDICARE: CAROLYN MARIE O'BRIEN

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	413098	NY

General Provider Information

NPI Number	:	1790338507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN MARIE O'BRIEN

Provider Business Mailing Address
First Line	:	39 ROYALE DR
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-8441
Country	:	US
Telephone Number	:	585-330-3578
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 ROYALE DR
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-8441
Country	:	US
Telephone Number	:	585-683-4039
Fax Number	:

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

Provider Enumeration Date	:	07/21/2019
Last Update Date	:	03/16/2026

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Directions to “ CAROLYN MARIE O'BRIEN ” Practice Location

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