Provider Demographics
NPI:1659041358
Name:JACOBS, BROOKE (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:KROGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, OTD
Mailing Address - Street 1:3223 OLIVIA BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2189
Mailing Address - Country:US
Mailing Address - Phone:563-370-4697
Mailing Address - Fax:
Practice Address - Street 1:3350 W SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2706
Practice Address - Country:US
Practice Address - Phone:407-846-0152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22030225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist