Provider Demographics
NPI:1861716938
Name:HARGIS-BROWN, LETICIA FAITH
Entity type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:FAITH
Last Name:HARGIS-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LETICIA
Other - Middle Name:FAITH
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:311 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-1315
Mailing Address - Country:US
Mailing Address - Phone:859-481-2631
Mailing Address - Fax:
Practice Address - Street 1:226 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-1250
Practice Address - Country:US
Practice Address - Phone:859-336-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3575225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist