Healthcare Provider Details

I. General information

NPI: 1467372375
Provider Name (Legal Business Name): BROOKE LYNN ROBERTS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 HIGHWAY 389
STARKVILLE MS
39759-8451
US

IV. Provider business mailing address

4869 STONEBRIDGE CV
TUPELO MS
38801-9499
US

V. Phone/Fax

Practice location:
  • Phone: 662-769-4888
  • Fax:
Mailing address:
  • Phone: 662-640-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-4005
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: