MEDICARE: MELISSA LYNN BROWN COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	4600	CA

General Provider Information

NPI Number	:	1952267759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LYNN BROWN COTA/L

Provider Business Mailing Address
First Line	:	4211 ILLINOIS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-1304
Country	:	US
Telephone Number	:	757-402-9773
Fax Number	:

Provider Business Practice Location Address
First Line	:	3707 CONVOY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-3754
Country	:	US
Telephone Number	:	858-573-9368
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/25/2025
Last Update Date	:	12/25/2025

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