Provider Demographics
NPI:1760641112
Name:BROOKS, ASHLEY ANN
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ANN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:MORAVEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4353 RUSTIC RD
Mailing Address - Street 2:
Mailing Address - City:CASTILE
Mailing Address - State:NY
Mailing Address - Zip Code:14427-9506
Mailing Address - Country:US
Mailing Address - Phone:716-665-8723
Mailing Address - Fax:
Practice Address - Street 1:200 W CONSTANCE RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4413
Practice Address - Country:US
Practice Address - Phone:757-539-8744
Practice Address - Fax:757-539-8764
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004573171W00000X
NY029311225X00000X
NY023911225X00000X
NY290311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171W00000XOther Service ProvidersContractor