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General NPI Number Information
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NPI Number | 1609305408
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Entity Type | Individual
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Provider Name | SHELLY ELAINE BROWN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 409 LEXINGTON ST
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City | WALTHAM
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State | MA
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Zip | 02452-0933
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Country | US
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Telephone | 781-647-9976
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 MYSTIC VALLEY PKWY APT 415
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City | MEDFORD
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State | MA
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Zip | 02155-5733
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Country | US
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Telephone | 503-484-6080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 377983
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number | 14642
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License Number State | MA
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