Provider Demographics
NPI:1952680613
Name:ADKISON, BROOKE (OTA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:ADKISON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 MEAD RD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1334
Mailing Address - Country:US
Mailing Address - Phone:361-212-6886
Mailing Address - Fax:
Practice Address - Street 1:4208 RETAMA CIR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2765
Practice Address - Country:US
Practice Address - Phone:361-582-0611
Practice Address - Fax:361-582-4978
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210484224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant