Provider Demographics
NPI:1548387798
Name:O'BRIEN, STEPHANIE RENEE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RENEE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2843
Mailing Address - Country:US
Mailing Address - Phone:443-783-2518
Mailing Address - Fax:
Practice Address - Street 1:205 ARMSTRONG ST
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2125
Practice Address - Country:US
Practice Address - Phone:410-758-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2846225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant