Provider Demographics
NPI:1528545670
Name:BROWN, AMBER KRISTIN (AT, LAT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:KRISTIN
Last Name:BROWN
Suffix:
Gender:F
Credentials:AT, LAT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:KRISTIN
Other - Last Name:KLEPACZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:123 E STATE ST APT 303
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1763
Mailing Address - Country:US
Mailing Address - Phone:801-548-8223
Mailing Address - Fax:
Practice Address - Street 1:1 HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:THE PLAINS
Practice Address - State:OH
Practice Address - Zip Code:45780-1148
Practice Address - Country:US
Practice Address - Phone:740-797-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-22
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10231442-48102255A2300X
OHAT0056782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer