Healthcare Provider Details

I. General information

NPI: 1205084860
Provider Name (Legal Business Name): PATRICIA GEORGINA BROCKINGTON-BROWN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA GEORGINA BROCKINGTON OTR

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD
LANHAM MD
20706-3574
US

IV. Provider business mailing address

7404 EXECUTIVE PL 300B
LANHAM MD
20706-2268
US

V. Phone/Fax

Practice location:
  • Phone: 301-599-9500
  • Fax: 301-856-7685
Mailing address:
  • Phone: 301-599-9500
  • Fax: 301-856-7685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number02997
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: