Provider Demographics
NPI:1316156425
Name:BROWN, BROOKE ALEXANDRA (COTA)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ALEXANDRA
Last Name:BROWN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:ALEXANDRA
Other - Last Name:ROSENSTEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1683 ROCK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:LOYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17047-9511
Mailing Address - Country:US
Mailing Address - Phone:717-789-4617
Mailing Address - Fax:
Practice Address - Street 1:801 N HANOVER ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-1599
Practice Address - Country:US
Practice Address - Phone:717-249-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006097224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant