Provider Demographics
NPI:1073983888
Name:BROWN, JASON (COTA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15761 NE BOB SANDERS RD
Mailing Address - Street 2:
Mailing Address - City:HOSFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32334-2639
Mailing Address - Country:US
Mailing Address - Phone:850-545-2098
Mailing Address - Fax:
Practice Address - Street 1:15761 NE BOB SANDERS RD
Practice Address - Street 2:
Practice Address - City:HOSFORD
Practice Address - State:FL
Practice Address - Zip Code:32334-2639
Practice Address - Country:US
Practice Address - Phone:850-545-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 10032224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant