Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023571585 |
---|---|
Provider Name | Autumn Rae Brown |
First Address | Hudsonville, MI 49426-1036 |
Second Address | Hudsonville, MI 49426-1036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2019 |
Last Update Date | 11/04/2019 |