Individual
NICOLE BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2950 H HWY, FARMINGTON, MO 63640-7047
(573) 330-7047
Mailing address
3863 CLEVELAND AVE, SAINT LOUIS, MO 63110-4009
(314) 664-3927
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2015044228
MO
374700000X
Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015044228
STATE OF MISSOURI
MO
Enumeration date
03/22/2016
Last updated
07/21/2022
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