Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 103K00000X | Behavior Analyst | ||
N | 106S00000X | Behavior Technician | ||
N | 225400000X | Rehabilitation Practitioner | ||
N | 225C00000X | Rehabilitation Counselor | ||
N | 225XN1300X | Occupational Therapist - Neurorehabilitation |
NPI | 1063003580 |
---|---|
Provider Name | Mieshio Brown |
First Address | Cumming, GA 30040-1282 |
Second Address | Atlanta, GA 30345-1845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2021 |
Last Update Date | 27/01/2021 |