Provider Demographics
NPI:1144066820
Name:LAMPTON, BROOKELYN ELYSE (COTA/L)
Entity type:Individual
Prefix:
First Name:BROOKELYN
Middle Name:ELYSE
Last Name:LAMPTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SWEET HOME RD
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-6542
Mailing Address - Country:US
Mailing Address - Phone:580-212-2353
Mailing Address - Fax:
Practice Address - Street 1:1405 E KIRK ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-3603
Practice Address - Country:US
Practice Address - Phone:580-317-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2445224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant