Provider Demographics
NPI:1053598722
Name:BROWN, LEILANI S (OTD / OTR/L)
Entity type:Individual
Prefix:
First Name:LEILANI
Middle Name:S
Last Name:BROWN
Suffix:
Gender:
Credentials:OTD / OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 PINNACLE DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8315
Mailing Address - Country:US
Mailing Address - Phone:817-475-3358
Mailing Address - Fax:
Practice Address - Street 1:2706 PINNACLE DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8315
Practice Address - Country:US
Practice Address - Phone:817-475-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108635225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T8722OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX193428301Medicaid