Provider Demographics
NPI:1366814485
Name:O'BRIEN, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:NY
Mailing Address - Zip Code:13783-0602
Mailing Address - Country:US
Mailing Address - Phone:800-330-7711
Mailing Address - Fax:
Practice Address - Street 1:40 MARTIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3938
Practice Address - Country:US
Practice Address - Phone:908-461-4168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117082225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist