Provider Demographics
NPI:1225235559
Name:OBRIEN, AMY TERESE (MSED, TVI)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:TERESE
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:MSED, TVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 JUSTINE CT
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-3456
Mailing Address - Country:US
Mailing Address - Phone:518-261-1990
Mailing Address - Fax:
Practice Address - Street 1:28 JUSTINE CT
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-9666
Practice Address - Country:US
Practice Address - Phone:518-261-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000875225A00000X
NY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Not Answered222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist