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General NPI Number Information
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NPI Number | 1801328513
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Entity Type | Organization
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Legal Business Name | BRENDA BROWN RN LMT LLC
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 2700 E MAIN ST SUITE 108
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City | BEXLEY
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State | OH
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Zip | 43209-2536
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Country | US
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Telephone | 614-579-0356
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 E MAIN ST SUITE 108
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City | BEXLEY
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State | OH
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Zip | 43209-2536
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Country | US
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Telephone | 614-579-0356
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETER
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Name | MISS BRENDA LOU BROWN
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Credential | MASSAGE THERAPIST
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Telephone | 614-579-0356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 33.006980
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License Number State | OH
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