Provider Demographics
NPI:1992154785
Name:BROWN, TINA (COTA/L)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LYNN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:626 HOMEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BIDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45614-9138
Mailing Address - Country:US
Mailing Address - Phone:740-612-9490
Mailing Address - Fax:
Practice Address - Street 1:626 HOMEWOOD DR
Practice Address - Street 2:
Practice Address - City:BIDWELL
Practice Address - State:OH
Practice Address - Zip Code:45614-9138
Practice Address - Country:US
Practice Address - Phone:740-612-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1930282NR1301X
OHOTA.05445282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural