Provider Demographics
NPI:1043580582
Name:O'BRIEN, DAPHNE RENEE (COTA)
Entity Type:Individual
Prefix:MS
First Name:DAPHNE
Middle Name:RENEE
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 BLACKSMITH DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-2530
Mailing Address - Country:US
Mailing Address - Phone:901-357-7078
Mailing Address - Fax:
Practice Address - Street 1:5151 BLACKSMITH DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-2530
Practice Address - Country:US
Practice Address - Phone:901-357-7078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2033224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant