Healthcare Provider Details

I. General information

NPI: 1053215608
Provider Name (Legal Business Name): SUSANNA SIEBOLD BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSANNE SIEBOLD BROWN

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11603 DONNER PASS RD
TRUCKEE CA
96161-4953
US

IV. Provider business mailing address

14813 ROYAL WAY
TRUCKEE CA
96161-1142
US

V. Phone/Fax

Practice location:
  • Phone: 530-386-0450
  • Fax:
Mailing address:
  • Phone: 530-386-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: