Provider Demographics
NPI:1477755825
Name:BROWN, TARA LADAWN (MS OTR-L, CLT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LADAWN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS OTR-L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29445 W 199TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-9514
Mailing Address - Country:US
Mailing Address - Phone:913-481-2306
Mailing Address - Fax:
Practice Address - Street 1:29445 W 199TH ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-9514
Practice Address - Country:US
Practice Address - Phone:913-481-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01862225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist