Provider Demographics
NPI:1669120739
Name:TAYLORED BY BROOKE
Entity type:Organization
Organization Name:TAYLORED BY BROOKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIC ORTHOTIC PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:CORMIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-281-2859
Mailing Address - Street 1:5520 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5138
Mailing Address - Country:US
Mailing Address - Phone:337-281-2859
Mailing Address - Fax:
Practice Address - Street 1:1008 CAMERON ST STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-5610
Practice Address - Country:US
Practice Address - Phone:337-281-2859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier