Provider Demographics
NPI:1790046209
Name:BROWN, JEQUEITA MONIQUE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:JEQUEITA
Middle Name:MONIQUE
Last Name:BROWN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:694 GREENWAY MANOR DR
Mailing Address - Street 2:APT B
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1387
Mailing Address - Country:US
Mailing Address - Phone:314-243-3734
Mailing Address - Fax:
Practice Address - Street 1:694 GREENWAY MANOR DR
Practice Address - Street 2:APT B
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-1387
Practice Address - Country:US
Practice Address - Phone:314-243-3734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008025678224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant