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Individual

CHRISTINE BOMEISL BROWN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT002476
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000835436A
PEACH STATE HEALTH PLAN
GA
05
000835436A
GA
01
10035959
AMERIGROUP
GA
01
312665
WELLCARE
GA
01
52825966 001
BLUE CROSS BLUE SHIELD
GA
01
52825966 002
BLUE CROSS BLUE SHIELD
GA
01
52825966 003
BLUE CROSS BLUE SHIELD
GA
Enumeration date
11/14/2006
Last updated
06/27/2011
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