Provider Demographics
NPI:1386246882
Name:FORRINGER, BROOKE (COTA/L)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:FORRINGER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CHICKASAW RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:PA
Mailing Address - Zip Code:16259-4014
Mailing Address - Country:US
Mailing Address - Phone:814-952-8391
Mailing Address - Fax:
Practice Address - Street 1:1515 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-4702
Practice Address - Country:US
Practice Address - Phone:724-349-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006632224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant