Provider Demographics
NPI:1013425198
Name:PATTERSON, BROOKE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:LAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:6048 KINGSGATE DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-9279
Mailing Address - Country:US
Mailing Address - Phone:859-393-5695
Mailing Address - Fax:
Practice Address - Street 1:7300 DEARWESTER DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6119
Practice Address - Country:US
Practice Address - Phone:513-373-4307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.005918224Z00000X
KY169106224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant