Provider Demographics
NPI:1669465456
Name:O'BRIEN, MARTHA JEAN (MS SLP/CCC)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JEAN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MS SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0468
Mailing Address - Country:US
Mailing Address - Phone:434-392-4910
Mailing Address - Fax:434-392-8793
Practice Address - Street 1:1412 W 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2648
Practice Address - Country:US
Practice Address - Phone:434-392-1596
Practice Address - Fax:434-392-5201
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3182528OtherAETNA
VA65549OtherSOUTHERN HEALTH
VA2111268OtherMAMSI
VA21148OtherUNICARE
VA14190OtherOPTIMA HEALTH
VA23591OtherCARE NET
VA386774OtherBLUE CROSS BLUE SHIELD
VA65549OtherSOUTHERN HEALTH