MEDICARE: AMY 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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1740578152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY BROWN

Provider Business Mailing Address
First Line	:	PO BOX 2998
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32790-2998
Country	:	US
Telephone Number	:	407-252-4651
Fax Number	:	407-641-8633

Provider Business Practice Location Address
First Line	:	4349 NEW BROAD ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814
Country	:	US
Telephone Number	:	407-252-4651
Fax Number	:

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

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	07/19/2011

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