Provider Demographics
NPI:1407004815
Name:BROWN, CHRISTINE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17261 SLIGO RD
Mailing Address - Street 2:
Mailing Address - City:KIMBOLTON
Mailing Address - State:OH
Mailing Address - Zip Code:43749-9604
Mailing Address - Country:US
Mailing Address - Phone:740-516-0047
Mailing Address - Fax:
Practice Address - Street 1:17261 SLIGO RD
Practice Address - Street 2:
Practice Address - City:KIMBOLTON
Practice Address - State:OH
Practice Address - Zip Code:43749-9604
Practice Address - Country:US
Practice Address - Phone:740-516-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA2050224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant