Provider Demographics
NPI:1508585688
Name:BROTHERS, JORDAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BROTHERS
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 1:1100 NORMAN ESKRIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-1724
Mailing Address - Country:US
Mailing Address - Phone:302-382-0348
Mailing Address - Fax:
Practice Address - Street 1:1100 NORMAN ESKRIDGE HWY
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-1724
Practice Address - Country:US
Practice Address - Phone:302-382-0348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU2-0012215224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant