Healthcare Provider Details

I. General information

NPI: 1578851523
Provider Name (Legal Business Name): DOROTHY C. BROWN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MONROE STREET ST JOHNSVILLE CENTRAL SCHOOL DISTRICT
ST JOHNSVILLE NY
13452
US

IV. Provider business mailing address

5892 WALKER RD.
UTICA NY
13502
US

V. Phone/Fax

Practice location:
  • Phone: 518-568-7023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000488
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: