Provider Demographics
NPI:1679124945
Name:BROWN, HOLLY ANN
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 KETTLE POND RD # 7
Mailing Address - Street 2:
Mailing Address - City:SHAPLEIGH
Mailing Address - State:ME
Mailing Address - Zip Code:04076-3665
Mailing Address - Country:US
Mailing Address - Phone:804-690-4187
Mailing Address - Fax:
Practice Address - Street 1:51 KETTLE POND RD
Practice Address - Street 2:
Practice Address - City:SHAPLEIGH
Practice Address - State:ME
Practice Address - Zip Code:04076-3665
Practice Address - Country:US
Practice Address - Phone:804-690-4187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist