Provider Demographics
NPI:1275052300
Name:BROWN, CHAD ALAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ALAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4625
Mailing Address - Country:US
Mailing Address - Phone:864-706-8016
Mailing Address - Fax:
Practice Address - Street 1:134 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-4625
Practice Address - Country:US
Practice Address - Phone:864-706-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3044224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant