Provider Demographics
NPI:1265554703
Name:BROWN, PATRICIA M (OTRL)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20402 KEY CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-1241
Mailing Address - Country:US
Mailing Address - Phone:661-607-2408
Mailing Address - Fax:
Practice Address - Street 1:6400 LAUREL CANYON BLVD STE 560
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1569
Practice Address - Country:US
Practice Address - Phone:818-763-0136
Practice Address - Fax:818-763-3838
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6635 OT225X00000X
225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT6635AMedicare PIN