Provider Demographics
NPI:1790309466
Name:BROWN, LOTTIE ADELEA
Entity Type:Individual
Prefix:
First Name:LOTTIE
Middle Name:ADELEA
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 RALEIGH ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-6435
Mailing Address - Country:US
Mailing Address - Phone:720-290-7713
Mailing Address - Fax:
Practice Address - Street 1:8723 WADSWORTH BLVD STE D
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80003-0921
Practice Address - Country:US
Practice Address - Phone:720-487-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0007195225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist