Provider Demographics
NPI:1356613764
Name:O'BRIEN, ANDREA (MS OTR/L)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WOODSTREAM CT
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2712
Mailing Address - Country:US
Mailing Address - Phone:315-796-1211
Mailing Address - Fax:
Practice Address - Street 1:500 WHITESBORO ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3015
Practice Address - Country:US
Practice Address - Phone:315-796-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017184225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist