Provider Demographics
NPI:1710197611
Name:BROWN, DAPHENE (MS, OTRL)
Entity Type:Individual
Prefix:MS
First Name:DAPHENE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 DISSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3704
Mailing Address - Country:US
Mailing Address - Phone:352-255-7784
Mailing Address - Fax:
Practice Address - Street 1:1018 DISSTON AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3704
Practice Address - Country:US
Practice Address - Phone:352-255-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11490225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist