Provider Demographics
NPI:1194084160
Name:O'BRIEN, TODD ROBERT (MOTR/L)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:ROBERT
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1528
Mailing Address - Country:US
Mailing Address - Phone:517-278-5933
Mailing Address - Fax:
Practice Address - Street 1:265 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1528
Practice Address - Country:US
Practice Address - Phone:517-278-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008272225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist