Provider Demographics
NPI:1215134887
Name:SHERMAN, BROOKE JESSAMINE (OTR)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:JESSAMINE
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3521
Mailing Address - Country:US
Mailing Address - Phone:740-441-5123
Mailing Address - Fax:
Practice Address - Street 1:545 W MOONGLO RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7710
Practice Address - Country:US
Practice Address - Phone:812-752-3499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004317A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist