Provider Demographics
NPI:1598941213
Name:BROWN, DIANNE IV (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:
Last Name:BROWN
Suffix:IV
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:DIANNE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:590 ROYAL POINCIANA CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1712
Mailing Address - Country:US
Mailing Address - Phone:954-384-6032
Mailing Address - Fax:954-384-1213
Practice Address - Street 1:590 ROYAL POINCIANA CT
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1712
Practice Address - Country:US
Practice Address - Phone:954-384-6032
Practice Address - Fax:954-384-1213
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA8818224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant