MEDICARE: MAUREEN 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	225100000X	Physical Therapist	0138581	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952378390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN O'BRIEN

Provider Business Mailing Address
First Line	:	PO BOX 387
Second Line	:	43 MALL
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196-0387
Country	:	US
Telephone Number	:	518-283-7374
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 RIDGEWOOD DR
Second Line	:
City	:	WYNANTSKILL
State	:	NY
Zip	:	12198-2824
Country	:	US
Telephone Number	:	518-674-1744
Fax Number	:

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	07/08/2007

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Directions to “ MAUREEN O'BRIEN ” Practice Location

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