Provider Demographics
NPI:1700072246
Name:O'BRIEN, CAROLINE THERESE (PT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:THERESE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E TINKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1536
Mailing Address - Country:US
Mailing Address - Phone:231-843-2676
Mailing Address - Fax:231-843-2209
Practice Address - Street 1:901 E TINKHAM AVE
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1536
Practice Address - Country:US
Practice Address - Phone:231-843-2676
Practice Address - Fax:231-843-2209
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E31033OtherBLUE CROSS BLUE SHIELD
MI0E31033OtherBLUE CROSS BLUE SHIELD
MI0P23170001Medicare UPIN