Healthcare Provider Details

I. General information

NPI: 1679692768
Provider Name (Legal Business Name): MRS. PATRICIA A BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PARK DR
WESTFORD MA
01886-3511
US

IV. Provider business mailing address

65 GORDON ST
LEOMINSTER MA
01453-6409
US

V. Phone/Fax

Practice location:
  • Phone: 978-392-1144
  • Fax:
Mailing address:
  • Phone: 978-466-7652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1269
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: