Provider Demographics
NPI:1033317748
Name:BROOKS, ELIZABETH LEE (COTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 MEADOW CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-1248
Mailing Address - Country:US
Mailing Address - Phone:636-257-1379
Mailing Address - Fax:
Practice Address - Street 1:7601 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5001
Practice Address - Country:US
Practice Address - Phone:314-961-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000161069224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant