Provider Demographics
NPI:1861904344
Name:O'BRIEN, ANN D (MA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:D
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:DORSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 2254
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-2254
Mailing Address - Country:US
Mailing Address - Phone:813-949-8766
Mailing Address - Fax:
Practice Address - Street 1:18489 N US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-7001
Practice Address - Country:US
Practice Address - Phone:813-949-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist