Provider Demographics
NPI:1376728311
Name:OBRIEN, JEAN RITA
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:RITA
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8967
Mailing Address - Country:US
Mailing Address - Phone:207-985-3030
Mailing Address - Fax:207-985-6428
Practice Address - Street 1:79 CAT MOUSAM RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6924
Practice Address - Country:US
Practice Address - Phone:207-985-3030
Practice Address - Fax:207-985-6428
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1885225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist