Provider Demographics
NPI:1902676422
Name:BROWN, OTHNIEL GEORGE
Entity Type:Individual
Prefix:
First Name:OTHNIEL
Middle Name:GEORGE
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 S GOLDENROD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8100
Mailing Address - Country:US
Mailing Address - Phone:407-783-6273
Mailing Address - Fax:407-237-9788
Practice Address - Street 1:733 S GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8100
Practice Address - Country:US
Practice Address - Phone:407-783-6273
Practice Address - Fax:407-237-9788
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty