Provider Demographics
NPI:1629754890
Name:BRADDOCK, BROOKE (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:
Last Name:BRADDOCK
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-7038
Mailing Address - Country:US
Mailing Address - Phone:609-410-8322
Mailing Address - Fax:
Practice Address - Street 1:178 RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-7038
Practice Address - Country:US
Practice Address - Phone:609-410-8322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist