Provider Demographics
NPI:1912951906
Name:ADAMSKI, BROOKE WYNN (OT)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:WYNN
Last Name:ADAMSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:WYNN
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:958 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9481
Mailing Address - Country:US
Mailing Address - Phone:989-430-9457
Mailing Address - Fax:989-835-9518
Practice Address - Street 1:958 WHEELER RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9481
Practice Address - Country:US
Practice Address - Phone:989-430-9457
Practice Address - Fax:989-835-9518
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004304208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation