Provider Demographics
NPI:1992562904
Name:BROWN, ANDREA JEAN (COTA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 E TVA RD
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-5284
Mailing Address - Country:US
Mailing Address - Phone:662-295-1127
Mailing Address - Fax:
Practice Address - Street 1:78 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MS
Practice Address - Zip Code:39341-2490
Practice Address - Country:US
Practice Address - Phone:662-295-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOTA3958224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant