Provider Demographics
NPI:1588923494
Name:BROWN, VANESSA MONIQUE (LMT)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:MONIQUE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 LEE RD S
Mailing Address - Street 2:13B
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-4541
Mailing Address - Country:US
Mailing Address - Phone:330-906-9156
Mailing Address - Fax:
Practice Address - Street 1:3180 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3314
Practice Address - Country:US
Practice Address - Phone:330-906-9156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.019526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist