Provider Demographics
NPI:1801936729
Name:BROWN, CECILIA LINDA (LMP)
Entity type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:LINDA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-1504
Mailing Address - Country:US
Mailing Address - Phone:509-488-3634
Mailing Address - Fax:509-488-3634
Practice Address - Street 1:445 S 11TH AVE
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1504
Practice Address - Country:US
Practice Address - Phone:509-488-3634
Practice Address - Fax:509-488-3634
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007497225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist