Healthcare Provider Details

I. General information

NPI: 1992140370
Provider Name (Legal Business Name): JILL MARIE BROWN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 E BAY RIDGE DR
AU GRES MI
48703-9532
US

IV. Provider business mailing address

2215 E BAY RIDGE DR
AU GRES MI
48703-9532
US

V. Phone/Fax

Practice location:
  • Phone: 989-493-3394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberL2225361
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: