Provider Demographics
NPI:1164421293
Name:OBRIEN, PATRICIA W (PT, DPT, OCS)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:W
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01012-9701
Mailing Address - Country:US
Mailing Address - Phone:413-296-4365
Mailing Address - Fax:
Practice Address - Street 1:39 CARLON DR
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2392
Practice Address - Country:US
Practice Address - Phone:413-727-3315
Practice Address - Fax:413-727-3316
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0316911Medicaid
MAY68442Medicare ID - Type Unspecified