Provider Demographics
NPI:1184963811
Name:O'BRIEN, FELICITY IRIS (SLP)
Entity type:Individual
Prefix:MRS
First Name:FELICITY
Middle Name:IRIS
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MILLPOND RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2215
Mailing Address - Country:US
Mailing Address - Phone:516-589-2320
Mailing Address - Fax:
Practice Address - Street 1:54 MILLPOND RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2215
Practice Address - Country:US
Practice Address - Phone:516-589-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022436235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist