Provider Demographics
NPI:1225508534
Name:LEWIS, BROOKELYN MIKIELA (OTR/L)
Entity Type:Individual
Prefix:
First Name:BROOKELYN
Middle Name:MIKIELA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 VALDEZ CIR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8000
Mailing Address - Country:US
Mailing Address - Phone:859-699-3397
Mailing Address - Fax:
Practice Address - Street 1:7210 BEACON WOODS DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1974
Practice Address - Country:US
Practice Address - Phone:727-863-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19205225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist