Provider Demographics
NPI:1871274399
Name:FOX, BROOKE ANN (CTRS)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ANN
Last Name:FOX
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11707 E BEAR MDWS SE
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:MI
Mailing Address - Zip Code:49302-9085
Mailing Address - Country:US
Mailing Address - Phone:517-899-4553
Mailing Address - Fax:
Practice Address - Street 1:11707 E BEAR MDWS SE
Practice Address - Street 2:
Practice Address - City:ALTO
Practice Address - State:MI
Practice Address - Zip Code:49302-9085
Practice Address - Country:US
Practice Address - Phone:517-899-4553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI83673225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist