Provider Demographics
NPI:1346562451
Name:CARTER, BROOKE EH (OTA)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:EH
Last Name:CARTER
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 SIDNEY ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7628
Mailing Address - Country:US
Mailing Address - Phone:870-612-7200
Mailing Address - Fax:870-612-7203
Practice Address - Street 1:1310 SIDNEY ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7628
Practice Address - Country:US
Practice Address - Phone:870-612-7200
Practice Address - Fax:870-612-7203
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTA 575224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant