Provider Demographics
NPI:1750898276
Name:GROGAN, BROOKE C (OTR/L)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:C
Last Name:GROGAN
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 1:9111 CEDAR RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7845
Mailing Address - Country:US
Mailing Address - Phone:704-817-2159
Mailing Address - Fax:252-201-8341
Practice Address - Street 1:9111 CEDAR RIVER RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7845
Practice Address - Country:US
Practice Address - Phone:704-817-2159
Practice Address - Fax:252-201-8341
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6386225X00000X
NC14301225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist