Provider Demographics
NPI:1962138990
Name:WINGATE, BROOKE (COTA/L)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WINGATE
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 1:2354 BLACKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8620
Mailing Address - Country:US
Mailing Address - Phone:252-714-0404
Mailing Address - Fax:
Practice Address - Street 1:250 LOVERS LN
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3436
Practice Address - Country:US
Practice Address - Phone:252-975-1636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant