Provider Demographics
NPI:1407923014
Name:BROOKS, HEATHER LEE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 WAGON WHEEL TRL
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3749
Mailing Address - Country:US
Mailing Address - Phone:636-294-5394
Mailing Address - Fax:
Practice Address - Street 1:700 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-2000
Practice Address - Country:US
Practice Address - Phone:573-324-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001025908225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist