Provider Demographics
NPI:1033741285
Name:BROOKSHER, IRENE RILEY (ATC)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:RILEY
Last Name:BROOKSHER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:RILEY
Other - Middle Name:
Other - Last Name:BROOKSHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1645 APPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-5910
Mailing Address - Country:US
Mailing Address - Phone:225-773-4896
Mailing Address - Fax:
Practice Address - Street 1:1645 APPLEWOOD RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-5910
Practice Address - Country:US
Practice Address - Phone:225-773-4896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3278412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer