Healthcare Provider Details

I. General information

NPI: 1740166487
Provider Name (Legal Business Name): CAROLYN BROWN OTD MOBILE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 CHERRY BROOK RD
CANTON CT
06019-4517
US

IV. Provider business mailing address

467 CHERRY BROOK RD
CANTON CT
06019-4517
US

V. Phone/Fax

Practice location:
  • Phone: 203-209-1898
  • Fax:
Mailing address:
  • Phone: 203-209-1898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN BROWN
Title or Position: OCCUPATIONAL THERAPIST
Credential:
Phone: 203-209-1898