Provider Demographics
NPI:1831162320
Name:BROWNE, JACK HOLLIDAY (OTR, CHT)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:HOLLIDAY
Last Name:BROWNE
Suffix:
Gender:M
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 CAMINITO EASTBLUFF
Mailing Address - Street 2:UNIT 124
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2878
Mailing Address - Country:US
Mailing Address - Phone:619-532-7135
Mailing Address - Fax:
Practice Address - Street 1:34730 BOB WILSON DR
Practice Address - Street 2:PHYSICAL AND OCCUPATIONAL THERAPY STE 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-3098
Practice Address - Country:US
Practice Address - Phone:619-532-7135
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6463225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand