MEDICARE: SYDRA BROWN

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	226000000X	Recreational Therapist Assistant

General Provider Information

NPI Number	:	1669267472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDRA BROWN

Provider Business Mailing Address
First Line	:	400 E 5350 S
Second Line	:
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-6931
Country	:	US
Telephone Number	:	801-479-9855
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E 5350 S
Second Line	:
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-6931
Country	:	US
Telephone Number	:	801-479-9855
Fax Number	:

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

Provider Enumeration Date	:	04/11/2025
Last Update Date	:	04/11/2025

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Directions to “ SYDRA BROWN ” Practice Location

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