Provider Demographics
NPI:1962035899
Name:BROOKS, ASHTON M (OTRL)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:ASHTON
Other - Middle Name:
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4285 DEVELOPMENT DRIVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911
Mailing Address - Country:US
Mailing Address - Phone:517-706-0421
Mailing Address - Fax:
Practice Address - Street 1:4285 DEVELOPMENT DRIVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911
Practice Address - Country:US
Practice Address - Phone:517-706-0421
Practice Address - Fax:517-706-0423
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010748225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist