Provider Demographics
NPI:1316015712
Name:MCCARTHY, BROOKE ARLENE (OTRL)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ARLENE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ARLENE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:352 N RENEE ST.
Mailing Address - Street 2:
Mailing Address - City:EAGAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85925
Mailing Address - Country:US
Mailing Address - Phone:928-333-0298
Mailing Address - Fax:
Practice Address - Street 1:352 NORTH RENEE STREET
Practice Address - Street 2:
Practice Address - City:EAGAR
Practice Address - State:AZ
Practice Address - Zip Code:85925
Practice Address - Country:US
Practice Address - Phone:928-333-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2180225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ552093Medicaid