Provider Demographics
NPI:1215179551
Name:SMALLWOOD, BROOKE CRABTREE (OT)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:CRABTREE
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 455
Mailing Address - Street 2:436 SOUTH MAIN STREET
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380
Mailing Address - Country:US
Mailing Address - Phone:606-663-8244
Mailing Address - Fax:606-663-8284
Practice Address - Street 1:436 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380
Practice Address - Country:US
Practice Address - Phone:606-663-8244
Practice Address - Fax:606-663-8284
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3327225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist