Provider Demographics
NPI:1588459804
Name:BROWN, EMMA MARIETTA (OTR/L)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:MARIETTA
Last Name:BROWN
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 NOYAC RD
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-1919
Mailing Address - Country:US
Mailing Address - Phone:631-276-4880
Mailing Address - Fax:
Practice Address - Street 1:3317 NOYAC RD
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-1919
Practice Address - Country:US
Practice Address - Phone:631-276-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03006201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist