Provider Demographics
NPI:1255212486
Name:BROOKS, TALIA MAMIE LEE
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:MAMIE LEE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 CHERRYLAND RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-1317
Mailing Address - Country:US
Mailing Address - Phone:443-839-6116
Mailing Address - Fax:
Practice Address - Street 1:2928 CHERRYLAND RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1317
Practice Address - Country:US
Practice Address - Phone:443-839-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer