Provider Demographics
NPI:1073229761
Name:BUFFINGTON, BROOKE ANGEL
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ANGEL
Last Name:BUFFINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 W COUNTY ROAD 75 S
Mailing Address - Street 2:
Mailing Address - City:FRENCH LICK
Mailing Address - State:IN
Mailing Address - Zip Code:47432-9605
Mailing Address - Country:US
Mailing Address - Phone:812-653-5082
Mailing Address - Fax:
Practice Address - Street 1:10305 W COUNTY ROAD 75 S
Practice Address - Street 2:
Practice Address - City:FRENCH LICK
Practice Address - State:IN
Practice Address - Zip Code:47432-9605
Practice Address - Country:US
Practice Address - Phone:812-653-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist