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General NPI Number Information
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NPI Number | 1710245287
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Entity Type | Organization
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Legal Business Name | JEREMIAH BROWN, INC
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 3945 24TH AVE SE APT 1
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City | NORMAN
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State | OK
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Zip | 73071-0817
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Country | US
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Telephone | 405-641-3651
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Fax |
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Provider Business Mailing Address
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Address Line | 3945 24TH AVE SE APT 1
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City | NORMAN
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State | OK
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Zip | 73071-0817
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Country | US
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Telephone | 405-641-3651
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEREMIAH RAY BROWN
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Credential | OTR/L
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Telephone | 405-641-3651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 1728
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License Number State | OK
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