MEDICARE: HEATHER NICOLE BROWN OTR/L

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

General Provider Information

NPI Number	:	1831639483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER NICOLE BROWN OTR/L

Provider Business Mailing Address
First Line	:	4524 BOAT CLUB RD
Second Line	:	STE 180
City	:	FORT WORTH
State	:	TX
Zip	:	76135-7025
Country	:	US
Telephone Number	:	817-764-3825
Fax Number	:

Provider Business Practice Location Address
First Line	:	4524 BOAT CLUB RD
Second Line	:	STE 180
City	:	FORT WORTH
State	:	TX
Zip	:	76135-7025
Country	:	US
Telephone Number	:	817-764-3825
Fax Number	:	844-233-7086

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

Provider Enumeration Date	:	03/01/2017
Last Update Date	:	12/16/2020

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