Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1043972516 |
---|---|
Provider Name | Dr. Olivia Claire Brown |
First Address | Bentonville, AR 72713-5622 |
Second Address | Bentonville, AR 72713-9292 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2021 |
Last Update Date | 12/10/2021 |