MEDICARE: MS. SARAH LYNN BROWN O.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5679355-4201	UT
2	225X00000X	Occupational Therapist	0573	SD

General Provider Information

NPI Number	:	1467562454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH LYNN BROWN O.T.

Provider Business Mailing Address
First Line	:	PO BOX 183
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57709-0183
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2453 BROADMOOR CT
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-5312
Country	:	US
Telephone Number	:	605-786-8007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/22/2010

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