Provider Demographics
NPI:1912279126
Name:BROWN, KATHRYN NICOLE
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 SANDPIPER LN APT 312
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-6270
Mailing Address - Country:US
Mailing Address - Phone:330-323-6463
Mailing Address - Fax:
Practice Address - Street 1:548 SANDPIPER LN APT 312
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-6270
Practice Address - Country:US
Practice Address - Phone:330-323-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.07581225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant