MEDICARE: BROOKE CARICO OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT21865	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336875905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE CARICO OTR

Provider Business Mailing Address
First Line	:	6806 POINTE OF WOODS DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33413-3803
Country	:	US
Telephone Number	:	301-873-6863
Fax Number	:

Provider Business Practice Location Address
First Line	:	3061 DONNELLY DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-6422
Country	:	US
Telephone Number	:	301-873-6863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	07/26/2022

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