MEDICARE: LAURA L BROWN OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1719	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336137041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA L BROWN OT

Provider Business Mailing Address
First Line	:	1350 WALTON WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2612
Country	:	US
Telephone Number	:	706-774-2166
Fax Number	:	706-774-7542

Provider Business Practice Location Address
First Line	:	1350 WALTON WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2612
Country	:	US
Telephone Number	:	706-774-2166
Fax Number	:	706-774-7542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	04/10/2013

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