Provider Demographics
NPI:1629393905
Name:O'BRIEN, MARY THERESA (RRT, NPS, AE-C)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:THERESA
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:RRT, NPS, AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MUSKET WAY
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-2829
Mailing Address - Country:US
Mailing Address - Phone:732-752-6159
Mailing Address - Fax:
Practice Address - Street 1:12 MUSKET WAY
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-2829
Practice Address - Country:US
Practice Address - Phone:732-752-6159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ43ZA001267002279P3900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredNeonatal/Pediatrics