Provider Demographics
NPI:1619244795
Name:BROWN, SALLY (MBA,OTR, CHT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MBA,OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 PEARL PKWY
Mailing Address - Street 2:STE 201
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3078
Mailing Address - Country:US
Mailing Address - Phone:303-449-2730
Mailing Address - Fax:303-604-6078
Practice Address - Street 1:4740 PEARL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3080
Practice Address - Country:US
Practice Address - Phone:303-449-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1819225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist