Provider Demographics
NPI:1770130981
Name:BROWN, ERICA LEE (LMT)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:LEE
Other - Last Name:FARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9031 MENTOR AVE.
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6463
Mailing Address - Country:US
Mailing Address - Phone:440-255-1315
Mailing Address - Fax:440-255-5832
Practice Address - Street 1:9031 MENTOR AVE.
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6463
Practice Address - Country:US
Practice Address - Phone:440-255-1315
Practice Address - Fax:440-255-5832
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.017531225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist