Provider Demographics
NPI:1609021518
Name:BROWN, JULIE CRUTCHFIELD (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:CRUTCHFIELD
Last Name:BROWN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CORTE DEL ORO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6902
Mailing Address - Country:US
Mailing Address - Phone:813-385-7628
Mailing Address - Fax:
Practice Address - Street 1:1120 VIA CALLEJON
Practice Address - Street 2:STE B
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6213
Practice Address - Country:US
Practice Address - Phone:949-498-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 13384225XP0200X
CA14651225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ171FOtherBLUE CROSS BLUE SHIELD OF FLORIDA
CA208983851OtherBEACH KIDS THERAPY CENTER, INC