Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0156-026 | WI |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 0156-026 | WI |
NPI | 1528128493 |
---|---|
Provider Name | Kevin D O'brien |
First Address | Madison, WI 53715-1507 |
Second Address | Madison, WI 53715-1507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 31/12/2014 |