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General NPI Number Information
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NPI Number | 1427614643
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Entity Type | Individual
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Provider Name | MAIZIE ANN BROWN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 3100 OLYMPUS BLVD
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City | COPPELL
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State | TX
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Zip | 75019-5472
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Country | US
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Telephone | 844-975-6706
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Fax |
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Provider Business Mailing Address
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Address Line | 7504 HIGH GROVE RD
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City | GRANDVIEW
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State | MO
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Zip | 64030-3434
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Country | US
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Telephone | 620-481-3170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA-1418
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 18-01584
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License Number State | KS
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