Provider Demographics
NPI:1326384058
Name:O'BRIEN, JILL (MS, ATC)
Entity type:Individual
Prefix:MISS
First Name:JILL
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12239 W WASHINGTON BLVD
Mailing Address - Street 2:APT B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5518
Mailing Address - Country:US
Mailing Address - Phone:805-801-0170
Mailing Address - Fax:
Practice Address - Street 1:1 LMU DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2650
Practice Address - Country:US
Practice Address - Phone:310-338-2340
Practice Address - Fax:310-338-5191
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7292255A2300X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer