Provider Demographics
NPI:1295450203
Name:BROWN, SHAYLA MONIQUE (COTA/L)
Entity type:Individual
Prefix:
First Name:SHAYLA
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:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 HIDDEN LAKE LOOP APT 143
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2895
Mailing Address - Country:US
Mailing Address - Phone:330-475-9110
Mailing Address - Fax:
Practice Address - Street 1:6455 HIDDEN LAKE LOOP APT 143
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2895
Practice Address - Country:US
Practice Address - Phone:330-475-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10118224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty