Provider Demographics
NPI:1730683244
Name:O'BRIAN, CASEY DIANE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:DIANE
Last Name:O'BRIAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9768 PINEY POINT CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6520
Mailing Address - Country:US
Mailing Address - Phone:321-202-0058
Mailing Address - Fax:
Practice Address - Street 1:2682 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3385
Practice Address - Country:US
Practice Address - Phone:407-960-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18991225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist