Provider Demographics
NPI:1497331466
Name:BROOKS-WATSON, TERRI-JO ANTOINETTE (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TERRI-JO
Middle Name:ANTOINETTE
Last Name:BROOKS-WATSON
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:MISS
Other - First Name:TERRI-JO
Other - Middle Name:ANTOINETTE
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA OTR/L
Mailing Address - Street 1:452 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-2008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:127 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4006
Practice Address - Country:US
Practice Address - Phone:914-751-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025421-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty