Healthcare Provider Details

I. General information

NPI: 1619899788
Provider Name (Legal Business Name): BROOKE THOMAS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 RIDGE RD STE 255
ROCKWALL TX
75087-5534
US

IV. Provider business mailing address

2455 RIDGE RD STE 255
ROCKWALL TX
75087-5534
US

V. Phone/Fax

Practice location:
  • Phone: 469-698-7719
  • Fax: 214-867-5470
Mailing address:
  • Phone: 469-698-7719
  • Fax: 214-867-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number112592
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: