Provider Demographics
NPI:1396861886
Name:BROWN, CLARA LYNN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:LYNN
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 1:720 MCCULLOUGH RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-1933
Mailing Address - Country:US
Mailing Address - Phone:304-675-6815
Mailing Address - Fax:
Practice Address - Street 1:200 S RITCHIE AVE
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1721
Practice Address - Country:US
Practice Address - Phone:304-273-9385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1515224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant