Provider Demographics
NPI:1316211006
Name:O'BRIEN, DIANNE LUCEY (MED,PT)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:LUCEY
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MED,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 EASTERN POINT DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2173
Mailing Address - Country:US
Mailing Address - Phone:508-775-7437
Mailing Address - Fax:
Practice Address - Street 1:28 EASTERN POINT DR
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2173
Practice Address - Country:US
Practice Address - Phone:508-757-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT3497171W00000X
MA3497174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171W00000XOther Service ProvidersContractor