Provider Demographics
NPI:1497220123
Name:O'BRIEN, ERIN (ATC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 W SAPPHIRE DR
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-3814
Mailing Address - Country:US
Mailing Address - Phone:815-814-3616
Mailing Address - Fax:
Practice Address - Street 1:1200 S MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7495
Practice Address - Country:US
Practice Address - Phone:815-455-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL096004198OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION