Provider Demographics
NPI:1760153118
Name:BROWN, DEVENNEY (COTA/L)
Entity Type:Individual
Prefix:
First Name:DEVENNEY
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
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:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:PAVO
Mailing Address - State:GA
Mailing Address - Zip Code:31778-0062
Mailing Address - Country:US
Mailing Address - Phone:229-200-3073
Mailing Address - Fax:
Practice Address - Street 1:5088 S COUNTY LINE ST
Practice Address - Street 2:
Practice Address - City:PAVO
Practice Address - State:GA
Practice Address - Zip Code:31778-3326
Practice Address - Country:US
Practice Address - Phone:229-200-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002612224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant