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NPI Code Detail

MEDICARE: OLIVIA GRACE BROWN MA, BCBA, LBA

MEDICARE: OLIVIA GRACE BROWN MA, BCBA, LBA
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
1103K00000XBehavior Analyst7401003227MI

General Provider Information

NPI Number : 1871234088
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA GRACE BROWN MA, BCBA, LBA
Provider Business Mailing Address
First Line : 53268 KAKOS DR
Second Line :
City : CHESTERFIELD
State : MI
Zip : 48051-3941
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 30330 HICKEY RD
Second Line :
City : CHESTERFIELD
State : MI
Zip : 48051-3911
Country : US
Telephone Number : 586-421-4062
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2022
Last Update Date : 03/02/2026

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