Provider Demographics
NPI:1902433428
Name:REES, AUSTIN BROWN (IBCLC, LMT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:BROWN
Last Name:REES
Suffix:
Gender:F
Credentials:IBCLC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 CROSS RD
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9869
Mailing Address - Country:US
Mailing Address - Phone:410-929-2688
Mailing Address - Fax:
Practice Address - Street 1:9401 CROSS RD
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-9869
Practice Address - Country:US
Practice Address - Phone:410-929-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL-27541174N00000X
MDM06032225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty