Provider Demographics
NPI:1811141690
Name:DABKOWSKI, BROOKE AMBER (COTA, CLT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:AMBER
Last Name:DABKOWSKI
Suffix:
Gender:F
Credentials:COTA, CLT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:AMBER
Other - Last Name:MCKEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA, CLT
Mailing Address - Street 1:1140 ARDMORE DR APT 102
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-6318
Mailing Address - Country:US
Mailing Address - Phone:443-301-9787
Mailing Address - Fax:
Practice Address - Street 1:1049 ANNA KNAPP BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3133
Practice Address - Country:US
Practice Address - Phone:843-654-0328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01833224Z00000X
IN32001663A224Z00000X
SC5160224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant