MEDICARE: CHRISTINA RENEE BROWN CTRS

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	225800000X	Recreation Therapist	50784	MS

General Provider Information

NPI Number	:	1528552320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA RENEE BROWN CTRS

Provider Business Mailing Address
First Line	:	1 JEFFERSON BARRACKS DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-4181
Country	:	US
Telephone Number	:	314-652-4100
Fax Number	:	314-894-5792

Provider Business Practice Location Address
First Line	:	4318 SUNRIDGE DR APT D
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-3472
Country	:	US
Telephone Number	:	601-918-3697
Fax Number	:

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

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	06/15/2018

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