Provider Demographics
NPI:1912429028
Name:O'BRIEN, CONOR (OTR/L)
Entity Type:Individual
Prefix:
First Name:CONOR
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21109 42ND AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2808
Mailing Address - Country:US
Mailing Address - Phone:845-702-7499
Mailing Address - Fax:
Practice Address - Street 1:6118 190TH ST STE 201
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2724
Practice Address - Country:US
Practice Address - Phone:718-454-0842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021225225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand