Healthcare Provider Details

I. General information

NPI: 1427290527
Provider Name (Legal Business Name): HAILEY RENE BROWN CPO, LPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BARBARA JORDAN BLVD STE 306
AUSTIN TX
78723-3080
US

IV. Provider business mailing address

1301 BARBARA JORDAN BLVD STE 306
AUSTIN TX
78723-3080
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-0011
  • Fax: 512-459-9522
Mailing address:
  • Phone: 512-459-0011
  • Fax: 512-459-9522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number1328
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number1328
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: