Provider Demographics
NPI:1275819468
Name:BROOKS, LISA MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:BROOKS
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:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-0381
Mailing Address - Country:US
Mailing Address - Phone:315-732-6911
Mailing Address - Fax:
Practice Address - Street 1:5176 STATE ROUTE 233
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:NY
Practice Address - Zip Code:13490
Practice Address - Country:US
Practice Address - Phone:315-557-2653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004320-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist