Provider Demographics
NPI:1174656284
Name:O'BRIEN, JOLENE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:MARIE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JOLENE
Other - Middle Name:MARIE
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2230 COUNTY ROUTE 126
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14839-9738
Mailing Address - Country:US
Mailing Address - Phone:607-225-4226
Mailing Address - Fax:
Practice Address - Street 1:134 SENECA ST
Practice Address - Street 2:GST BOCES
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1324
Practice Address - Country:US
Practice Address - Phone:607-324-1525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022583-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist