Provider Demographics
NPI:1538221668
Name:O'BRIEN, TIMOTHY E (DAC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:E
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:OPUS ACUPUNCTURE
Mailing Address - City:WYOMING
Mailing Address - State:RI
Mailing Address - Zip Code:02898
Mailing Address - Country:US
Mailing Address - Phone:401-397-6333
Mailing Address - Fax:401-397-3124
Practice Address - Street 1:66 NOOSENECK HILL RD
Practice Address - Street 2:OPUS ACUPUNCTURE
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817-1523
Practice Address - Country:US
Practice Address - Phone:401-397-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00149171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDA001491OtherACUPUNCTURE