Provider Demographics
NPI:1750652970
Name:OBRIEN, CORIE JESSICA (BA, COTA)
Entity Type:Individual
Prefix:MRS
First Name:CORIE
Middle Name:JESSICA
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:BA, COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:360 KNICKERBOCKER RD
Mailing Address - Street 2:UNIT 11
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3196 KENNEDY BLVD
Practice Address - Street 2:SPORTSCARE 3RD FLOOR
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2436
Practice Address - Country:US
Practice Address - Phone:201-223-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09000300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist