=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255022745
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA JEAN BROWN-OTIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2023
-----------------------------------------------------
Last Update Date | 05/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15221 CARROLLTON BLVD STE 209
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23314-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-745-7105
-----------------------------------------------------
Fax | 757-745-7250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15221 CARROLLTON BLVD STE 209
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23314-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-745-7105
-----------------------------------------------------
Fax | 757-745-7250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | HCO-253083
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------