Provider Demographics
NPI:1487706701
Name:BROOME, LANA KAREEN (OTR)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:KAREEN
Last Name:BROOME
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:KAREEN
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:298 WARFIELD BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1896
Mailing Address - Country:US
Mailing Address - Phone:931-906-0440
Mailing Address - Fax:931-920-5070
Practice Address - Street 1:298 WARFIELD BLVD APT C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-1896
Practice Address - Country:US
Practice Address - Phone:931-906-0440
Practice Address - Fax:931-920-5070
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2156225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4004828OtherBCBS GROUP ID NUMBER
TN4004828OtherTENNCARE ID NUMBER
TN4004828OtherBCBS GROUP ID NUMBER