Provider Demographics
NPI:1356300693
Name:BROWN, GLORIA ANN (MS OTRL CHT)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS OTRL CHT
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:ANN
Other - Last Name:RODAKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:715 FRONTIER DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011
Mailing Address - Country:US
Mailing Address - Phone:505-635-3963
Mailing Address - Fax:
Practice Address - Street 1:125 W HAGUE RD STE 310
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5806
Practice Address - Country:US
Practice Address - Phone:915-996-3404
Practice Address - Fax:915-307-2331
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM585225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand