Provider Demographics
NPI:1992131965
Name:BROOKS, JIRI MICHAEL (MSOTR/L)
Entity type:Individual
Prefix:
First Name:JIRI
Middle Name:MICHAEL
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10402 GOLDEN HEARTH LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2830
Mailing Address - Country:US
Mailing Address - Phone:713-416-6086
Mailing Address - Fax:
Practice Address - Street 1:10402 GOLDEN HEARTH LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-2830
Practice Address - Country:US
Practice Address - Phone:713-416-6086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-22
Last Update Date:2013-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113337225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist