Basic Information
| Provider Information | |||||||||
| NPI: | 1619244795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | SALLY | ||||||||
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| Credential: | MBA,OTR, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4740 PEARL PKWY | ||||||||
| Address2: | STE 201 | ||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803013078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034492730 | ||||||||
| FaxNumber: | 3036046078 | ||||||||
| Practice Location | |||||||||
| Address1: | 933 ALPINE AVE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803043305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034492730 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2011 | ||||||||
| LastUpdateDate: | 12/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1819 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.