Provider Demographics
NPI:1588762439
Name:BROWN, CASEY DYAN (OTR, PTA)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:DYAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTR, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BRIERCROFT OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-3011
Mailing Address - Country:US
Mailing Address - Phone:806-795-7433
Mailing Address - Fax:806-795-7407
Practice Address - Street 1:3223 S LOOP 289
Practice Address - Street 2:SUITE 101
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1337
Practice Address - Country:US
Practice Address - Phone:806-792-5522
Practice Address - Fax:806-785-7582
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106260225X00000X
TX2015368225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J9376Medicare PIN