Provider Demographics
NPI:1528539491
Name:PAMPLONA, BROOK ELIZABETH (COTA/L)
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:ELIZABETH
Last Name:PAMPLONA
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 1:304 SAN GABRIEL AVE
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1806
Mailing Address - Country:US
Mailing Address - Phone:805-234-5135
Mailing Address - Fax:
Practice Address - Street 1:21 ZACA LN
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7344
Practice Address - Country:US
Practice Address - Phone:805-234-5135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3955225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics