Provider Demographics
NPI:1891223822
Name:BROWN, TRACEY LYNN (COTA/L)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:LYNN
Other - Last Name:STOGDILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 S CANAL DR UNIT 122
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-0806
Mailing Address - Country:US
Mailing Address - Phone:937-477-9734
Mailing Address - Fax:
Practice Address - Street 1:900 S CANAL DR UNIT 122
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-0806
Practice Address - Country:US
Practice Address - Phone:937-477-9734
Practice Address - Fax:937-684-3585
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-04
Last Update Date:2017-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6432224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant