Provider Demographics
NPI:1548518483
Name:LAFFERTY, BROOKE (OTR/L)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2859 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5421
Mailing Address - Country:US
Mailing Address - Phone:772-834-4624
Mailing Address - Fax:
Practice Address - Street 1:2385 NORTHSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2702
Practice Address - Country:US
Practice Address - Phone:619-757-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 15333225X00000X
CA14117225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist