Provider Demographics
NPI:1144672452
Name:BROOKS, MARY (ATC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:STOCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2783 ARROWHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-9604
Mailing Address - Country:US
Mailing Address - Phone:513-344-1100
Mailing Address - Fax:
Practice Address - Street 1:2783 ARROWHEAD TRL
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-9604
Practice Address - Country:US
Practice Address - Phone:513-344-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0046962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer