Provider Demographics
NPI:1255022745
Name:BROWN-OTIS, BARBARA JEAN
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:BROWN-OTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:BROWN-OTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HOME HEALTH OWNER
Mailing Address - Street 1:15221 CARROLLTON BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-2325
Mailing Address - Country:US
Mailing Address - Phone:757-745-7105
Mailing Address - Fax:757-745-7250
Practice Address - Street 1:15221 CARROLLTON BLVD STE 209
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-2325
Practice Address - Country:US
Practice Address - Phone:757-745-7105
Practice Address - Fax:757-745-7250
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-253083374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty