Provider Demographics
NPI:1639751282
Name:BROWNFIEL, LANDON ALICIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:ALICIA
Last Name:BROWNFIEL
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 1:164 COUNTY ROAD 137
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-7251
Mailing Address - Country:US
Mailing Address - Phone:870-323-2495
Mailing Address - Fax:
Practice Address - Street 1:164 COUNTY ROAD 137
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-7251
Practice Address - Country:US
Practice Address - Phone:870-323-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020039663224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant