Provider Demographics
NPI:1881937795
Name:BROWN, MONIQUE R (MOTR/L)
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 AVY ST
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2214
Mailing Address - Country:US
Mailing Address - Phone:302-528-8877
Mailing Address - Fax:
Practice Address - Street 1:925 BEAR CORBITT RD
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1323
Practice Address - Country:US
Practice Address - Phone:302-528-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0001348225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEU1-0001348OtherOCCUPATIONAL THERAPIST
DEU1-0001348OtherOCCUPATIONAL THERAPIST