Provider Demographics
NPI:1932753472
Name:WARREN, ADELINE BROOKE
Entity type:Individual
Prefix:
First Name:ADELINE
Middle Name:BROOKE
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 ARIVA LANE APT 303
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812
Mailing Address - Country:US
Mailing Address - Phone:863-393-8030
Mailing Address - Fax:
Practice Address - Street 1:512 S 11TH STREET
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853
Practice Address - Country:US
Practice Address - Phone:863-676-8592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist