Healthcare Provider Details

I. General information

NPI: 1376081877
Provider Name (Legal Business Name): MOLLY BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E MAIN ST #310
WYTHEVILLE VA
24382-2062
US

IV. Provider business mailing address

800 E MAIN STREET #310
WYTHEVILLE VA
24382
US

V. Phone/Fax

Practice location:
  • Phone: 276-228-6200
  • Fax:
Mailing address:
  • Phone: 276-228-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: