MEDICARE: MRS. LYDIA ASHLEY BROOKS-DANIELS OTR/L

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	225XP0200X	Pediatric Occupational Therapist	17331	NC

General Provider Information

NPI Number	:	1972313088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYDIA ASHLEY BROOKS-DANIELS OTR/L

Provider Business Mailing Address
First Line	:	642 LITTLE PLUMTREE CREEK RD
Second Line	:
City	:	NEWLAND
State	:	NC
Zip	:	28657-9548
Country	:	US
Telephone Number	:	828-964-0219
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 LEDGER SCHOOL RD
Second Line	:
City	:	BAKERSVILLE
State	:	NC
Zip	:	28705-7260
Country	:	US
Telephone Number	:	828-776-2220
Fax Number	:	828-766-2221

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

Provider Enumeration Date	:	01/10/2025
Last Update Date	:	05/18/2026

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