Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 122219 | TX |
NPI | 1023774791 |
---|---|
Provider Name | Elaine Madison Brown |
First Address | Flower Mound, TX 75022-4919 |
Second Address | Flower Mound, TX 75077-2150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2021 |
Last Update Date | 16/11/2021 |