Provider Demographics
NPI:1023167855
Name:BROWN, TERRA ANITA (OTR,)
Entity type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:ANITA
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTR,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 KELLER PARKWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3876
Mailing Address - Country:US
Mailing Address - Phone:817-562-3111
Mailing Address - Fax:817-562-3114
Practice Address - Street 1:1652 KELLER PARKWAY
Practice Address - Street 2:STE 100
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3876
Practice Address - Country:US
Practice Address - Phone:817-562-3111
Practice Address - Fax:817-562-3114
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR 1614225XP0200X
TX116116225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142612721Medicaid