Provider Demographics
NPI:1457433294
Name:O'BRIEN, CHRISTOPHER WILLIAM (PHD, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WILLIAM
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:PHD, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 MARY JO DR
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:PA
Mailing Address - Zip Code:18434-1965
Mailing Address - Country:US
Mailing Address - Phone:570-430-9225
Mailing Address - Fax:
Practice Address - Street 1:KING'S COLLEGE
Practice Address - Street 2:133 NORTH RIVER STREET
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711
Practice Address - Country:US
Practice Address - Phone:570-208-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001603-12255A2300X
PART001243A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001603-1OtherOFFICE OF THE PROFESSIONS, THE UNIVERSITY OF THE STATE OF NY EDUCATION DEPT.
PART001243AOtherBUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS, PA DEPT. OF STATE