Provider Demographics
NPI:1316563166
Name:BROWN, ANNIE J (MT)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:J
Last Name:BROWN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2246
Mailing Address - Country:US
Mailing Address - Phone:419-756-6111
Mailing Address - Fax:419-756-2549
Practice Address - Street 1:990 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2246
Practice Address - Country:US
Practice Address - Phone:419-756-6111
Practice Address - Fax:419-756-2549
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
33.024856225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist