Basic Information
Provider Information
NPI: 1447751078
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: NANCY
MiddleName: F
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3030 NW EXPRESSWAY
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731125474
CountryCode: US
TelephoneNumber: 4059177160
FaxNumber:  
Practice Location
Address1: 3300 NW EXPRESSWAY
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731124418
CountryCode: US
TelephoneNumber: 4059493253
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/28/2018
LastUpdateDate: 02/28/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
224Z00000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant 

No ID Information.


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