Provider Demographics
NPI:1114547783
Name:BROWN, ERIC WAYNE (CRT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:WAYNE
Last Name:BROWN
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 WAYSIDE DR E
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-2619
Mailing Address - Country:US
Mailing Address - Phone:270-231-9525
Mailing Address - Fax:
Practice Address - Street 1:3000 ALVEY PARK DR W STE F
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2104
Practice Address - Country:US
Practice Address - Phone:270-683-3661
Practice Address - Fax:270-683-3662
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY71392278E1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedEducational