=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609712702
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMERIE BROOKS OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2026
-----------------------------------------------------
Last Update Date | 04/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3140 WATERMAN WAY
-----------------------------------------------------
City | TAVARES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32778-5252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-253-3892
-----------------------------------------------------
Fax | 352-253-3809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30700 KUMQUAT AVE
-----------------------------------------------------
City | EUSTIS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32736-8144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-885-1332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT26518
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------