Healthcare Provider Details

I. General information

NPI: 1780628867
Provider Name (Legal Business Name): SONJA LEWIS BROWN OCCUPATIONAL THERAPI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SONJA J LEWIS OCCUPATIONAL THERAPI

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4754 WOODMERE BLVD
MONTGOMERY AL
36106-3088
US

IV. Provider business mailing address

PO BOX 231322
MONTGOMERY AL
36123-1322
US

V. Phone/Fax

Practice location:
  • Phone: 334-356-8543
  • Fax: 334-356-8503
Mailing address:
  • Phone: 334-356-8543
  • Fax: 334-356-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0360
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: