Provider Demographics
NPI:1447497565
Name:BROOKS, ALISSA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:248 MERRIFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2912
Mailing Address - Country:US
Mailing Address - Phone:917-733-5215
Mailing Address - Fax:
Practice Address - Street 1:248 MERRIFIELD AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2912
Practice Address - Country:US
Practice Address - Phone:917-733-5215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008557-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist