Provider Demographics
NPI:1366830192
Name:BROWN, JENNIFER RYE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RYE
Last Name:BROWN
Suffix:
Gender:F
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 1:305 NE DELAWARE AVE APT 115
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-6610
Mailing Address - Country:US
Mailing Address - Phone:704-998-7022
Mailing Address - Fax:
Practice Address - Street 1:305 NE DELAWARE AVE APT 115
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-6610
Practice Address - Country:US
Practice Address - Phone:704-998-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-01
Last Update Date:2015-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072764224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant