Provider Demographics
NPI:1386730265
Name:STANTON, BROOKE S (MS OTR)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:S
Last Name:STANTON
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 WHITLOCK RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2103
Mailing Address - Country:US
Mailing Address - Phone:920-905-1199
Mailing Address - Fax:
Practice Address - Street 1:14 ELLIS POTTER CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2478
Practice Address - Country:US
Practice Address - Phone:608-204-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4334-026225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics