Provider Demographics
NPI:1023261054
Name:O'BRIEN, VIRGINIA (OTR/L, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:VIRGINIA
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:OTR/L, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 BEACH 102ND STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:917-721-5334
Mailing Address - Fax:
Practice Address - Street 1:321 BEACH 102ND ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2867
Practice Address - Country:US
Practice Address - Phone:917-721-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025409-01235Z00000X
NY008207-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist