Healthcare Provider Details

I. General information

NPI: 1588762793
Provider Name (Legal Business Name): BETHANY LEAH BROWN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 KAILUA RD STE 102B
KAILUA HI
96734-3420
US

IV. Provider business mailing address

1 JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER
TAMC HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-400-0073
  • Fax:
Mailing address:
  • Phone: 808-433-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number376
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number376
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number376
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: