Provider Demographics
NPI:1386434793
Name:LATTERNER, BROOKE NICOLE (COTA/L)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:LATTERNER
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 1:9093 RIDGEFIELD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6711
Mailing Address - Country:US
Mailing Address - Phone:301-846-4769
Mailing Address - Fax:301-846-0059
Practice Address - Street 1:9093 RIDGEFIELD DR STE 102
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6711
Practice Address - Country:US
Practice Address - Phone:301-846-4769
Practice Address - Fax:301-846-0059
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD510754224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant