Provider Demographics
NPI:1750098596
Name:BROOKS, MICHAELA (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E 106TH ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4639
Mailing Address - Country:US
Mailing Address - Phone:502-689-0373
Mailing Address - Fax:
Practice Address - Street 1:170 E 106TH ST APT 5F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4639
Practice Address - Country:US
Practice Address - Phone:502-689-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty