Provider Demographics
NPI:1053627661
Name:BROWN, MICAH JUNE (COTA)
Entity Type:Individual
Prefix:MS
First Name:MICAH
Middle Name:JUNE
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 1:1503 LINCOLN ST
Mailing Address - Street 2:#103
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229
Mailing Address - Country:US
Mailing Address - Phone:651-239-0258
Mailing Address - Fax:
Practice Address - Street 1:1503 LINCOLN ST
Practice Address - Street 2:#103
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229
Practice Address - Country:US
Practice Address - Phone:651-239-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant