Healthcare Provider Details

I. General information

NPI: 1992665244
Provider Name (Legal Business Name): KAITLYN BROOKS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 W 30TH AVE
EUGENE OR
97405-3485
US

IV. Provider business mailing address

1130 COOPER AVE
COTTAGE GROVE OR
97424-2771
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-5901
  • Fax:
Mailing address:
  • Phone: 541-232-6425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number10202
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: