Provider Demographics
NPI:1609490119
Name:BROWN, MICHELLE KATHRYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KATHRYN
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 E PETTIGREW ST APT 134
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4462
Mailing Address - Country:US
Mailing Address - Phone:540-742-2668
Mailing Address - Fax:
Practice Address - Street 1:504 E PETTIGREW ST APT 134
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-4462
Practice Address - Country:US
Practice Address - Phone:540-742-2668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13294225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist