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General NPI Number Information
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NPI Number | 1679367767
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Entity Type | Individual
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Provider Name | BROOKE LUNSFORD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2025
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Last Update Date | 04/05/2025
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Provider Practice Location Address
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Address Line | 2288 DREW ST STE C
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City | CLEARWATER
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State | FL
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Zip | 33765-3307
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Country | US
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Telephone | 727-481-9985
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Fax |
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Provider Business Mailing Address
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Address Line | 1256 STONY BROOK LN
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City | DUNEDIN
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State | FL
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Zip | 34698-4824
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Country | US
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Telephone | 720-648-1388
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA19438
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License Number State | FL
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