Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2000161069 | MO |
NPI | 1033317748 |
---|---|
Provider Name | Elizabeth Lee Brooks |
First Address | Pacific, MO 63069-1248 |
Second Address | Saint Louis, MO 63119-5001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 08/07/2007 |