Healthcare Provider Details

I. General information

NPI: 1861304263
Provider Name (Legal Business Name): MICHAEL JODECARLO BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 2ND ST SE
WINTER HAVEN FL
33880-6300
US

IV. Provider business mailing address

6859 HUNTERS CROSSING BLVD
LAKELAND FL
33809-3385
US

V. Phone/Fax

Practice location:
  • Phone: 863-268-2903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA20623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: