Provider Demographics
NPI:1053903450
Name:BROWN, TABITHA
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 S LITTLE SAND MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ARMUCHEE
Mailing Address - State:GA
Mailing Address - Zip Code:30105-4049
Mailing Address - Country:US
Mailing Address - Phone:706-859-1372
Mailing Address - Fax:
Practice Address - Street 1:600 EAGLE LAKE TRL
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2207
Practice Address - Country:US
Practice Address - Phone:706-728-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001795224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant