Individual
MICAH BENJAMIN O'BRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
4560 SE INTERNATIONAL WAY, MILWAUKIE, OR 97222-4628
(971) 206-5202
Mailing address
25829 185TH PL SE, COVINGTON, WA 98042-8446
(206) 354-7103
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
P160560447
WA
Other
Enumeration date
09/08/2015
Last updated
09/08/2015
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