Provider Demographics
NPI:1659094332
Name:O'BRIEN, KATHRYN PATRICIA (DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PATRICIA
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 ORCHARD SHADE RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-2457
Mailing Address - Country:US
Mailing Address - Phone:973-903-1518
Mailing Address - Fax:
Practice Address - Street 1:4924 CAMPBELL BLVD STE 130A
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5909
Practice Address - Country:US
Practice Address - Phone:443-442-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist