=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780480749
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMELIA ROSE BROWN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2025
-----------------------------------------------------
Last Update Date | 02/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4977 NASHVILLE HWY
-----------------------------------------------------
City | DEER LODGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37726-3413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-302-9287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4977 NASHVILLE HWY
-----------------------------------------------------
City | DEER LODGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37726-3413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-364-0083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------