Provider Demographics
NPI:1336540947
Name:GOLDSMITH, BROOKE ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANN
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 NE SHERMAN LN
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-1849
Mailing Address - Country:US
Mailing Address - Phone:641-418-0199
Mailing Address - Fax:
Practice Address - Street 1:1507 OLDE HICKORY RD
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1118
Practice Address - Country:US
Practice Address - Phone:641-418-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074827224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant