Provider Demographics
NPI:1962503953
Name:BROWN, CHARLES STANLEY (OTR L CHT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:STANLEY
Last Name:BROWN
Suffix:
Gender:M
Credentials:OTR L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 HUNN RD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993
Mailing Address - Country:US
Mailing Address - Phone:530-671-9007
Mailing Address - Fax:
Practice Address - Street 1:1133 GRAY AVE
Practice Address - Street 2:STE C
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991
Practice Address - Country:US
Practice Address - Phone:530-790-7081
Practice Address - Fax:530-790-7057
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAA228726225X00000X
CAOT5525225X00000X
CA9105000156225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand