Provider Demographics
NPI:1144879941
Name:BRAZZLE, CANAAN (COTA)
Entity type:Individual
Prefix:
First Name:CANAAN
Middle Name:
Last Name:BRAZZLE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:CANAAN
Other - Middle Name:
Other - Last Name:BIANCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:9975 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3316
Mailing Address - Country:US
Mailing Address - Phone:301-301-7389
Mailing Address - Fax:
Practice Address - Street 1:9975 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3316
Practice Address - Country:US
Practice Address - Phone:301-301-7389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT00411224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant