Basic Information
| Provider Information | |||||||||
| NPI: | 1215179551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMALLWOOD | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | CRABTREE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | O.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 455 | ||||||||
| Address2: | 436 SOUTH MAIN STREET | ||||||||
| City: | STANTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066638244 | ||||||||
| FaxNumber: | 6066638284 | ||||||||
| Practice Location | |||||||||
| Address1: | 436 SOUTH MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | STANTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066638244 | ||||||||
| FaxNumber: | 6066638284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2009 | ||||||||
| LastUpdateDate: | 04/01/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | R3327 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.