Provider Demographics
NPI:1366713836
Name:RAY-BROWN, PATRICIA ANN (OTA)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:RAY-BROWN
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:2141 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2013
Mailing Address - Country:US
Mailing Address - Phone:502-895-5417
Mailing Address - Fax:502-895-3358
Practice Address - Street 1:2141 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2013
Practice Address - Country:US
Practice Address - Phone:502-895-5417
Practice Address - Fax:502-895-3358
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA4134224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant