Basic Information
| Provider Information | |||||||||
| NPI: | 1942283916 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'BRIEN | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 SUGAR TREE PL | ||||||||
| Address2: | |||||||||
| City: | COCKEYSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210303185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106676535 | ||||||||
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| Practice Location | |||||||||
| Address1: | TOWSON UNIVERSITY - ATHLETICS SPORTS MEDICINE | ||||||||
| Address2: | 8000 YORK RD. FIELD HOUSE 101 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212520001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107043606 | ||||||||
| FaxNumber: | 4107042727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.