Provider Demographics
NPI:1437923422
Name:BROOKS, MORIAH NICOLE SUE (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:MORIAH
Middle Name:NICOLE SUE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 S SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:MO
Mailing Address - Zip Code:64020-9620
Mailing Address - Country:US
Mailing Address - Phone:660-525-4566
Mailing Address - Fax:
Practice Address - Street 1:501 SE 12TH ST
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-9384
Practice Address - Country:US
Practice Address - Phone:816-690-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023031911224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant