Healthcare Provider Details

I. General information

NPI: 1730834714
Provider Name (Legal Business Name): LAURA A BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

300 LYME CT
RALEIGH NC
27609-3719
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-7000
  • Fax:
Mailing address:
  • Phone: 630-484-8407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number10258
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: