Provider Demographics
NPI:1659730711
Name:BROWN, LEA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LEA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CHERRYWOOD CT
Mailing Address - Street 2:UNIT 607
Mailing Address - City:INDIAN HEAD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4431
Mailing Address - Country:US
Mailing Address - Phone:708-420-5995
Mailing Address - Fax:
Practice Address - Street 1:29 CHERRYWOOD CT
Practice Address - Street 2:UNIT 607
Practice Address - City:INDIAN HEAD PARK
Practice Address - State:IL
Practice Address - Zip Code:60525-4431
Practice Address - Country:US
Practice Address - Phone:708-420-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.010354225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist