Healthcare Provider Details

I. General information

NPI: 1952537334
Provider Name (Legal Business Name): AMANDA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2009
Last Update Date: 05/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3485 DAVISVILLE RD
HATBORO PA
19040-4220
US

IV. Provider business mailing address

333 1ST ST N SUITE 200
JACKSONVILLE BEACH FL
32250-6945
US

V. Phone/Fax

Practice location:
  • Phone: 215-830-0400
  • Fax:
Mailing address:
  • Phone: 888-909-5038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP006186
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: