Provider Demographics
NPI:1700433554
Name:BROWN, TIANA CHRISTINA (OTR)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:CHRISTINA
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:TIANA
Other - Middle Name:CHRISTINA
Other - Last Name:POLITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4183
Mailing Address - Country:US
Mailing Address - Phone:701-780-2512
Mailing Address - Fax:
Practice Address - Street 1:1375 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4015
Practice Address - Country:US
Practice Address - Phone:701-780-2512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND425151225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist