Provider Demographics
NPI:1154334902
Name:BROOKS, TRACY CALHOUN (LOTR)
Entity type:Individual
Prefix:MR
First Name:TRACY
Middle Name:CALHOUN
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 ARKANSAS RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-8611
Mailing Address - Country:US
Mailing Address - Phone:318-396-2044
Mailing Address - Fax:318-396-2204
Practice Address - Street 1:2409 ARKANSAS RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-8611
Practice Address - Country:US
Practice Address - Phone:318-396-2044
Practice Address - Fax:318-396-2204
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAACS PROVIDER NUMBEROtherFED WORK COMP PROVIDER #
LAACS PROVIDER NUMBEROtherFED WORK COMP PROVIDER #