Provider Demographics
NPI:1205496346
Name:JEFFREY BROWN, LISA JEAN (OTR/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:JEFFREY BROWN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2225 9TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-3008
Mailing Address - Country:US
Mailing Address - Phone:701-739-6403
Mailing Address - Fax:
Practice Address - Street 1:1505 CENTRAL AVE NW
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1301
Practice Address - Country:US
Practice Address - Phone:701-739-6403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100408225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics