Brooke R Nikitich, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

46TA09150500 Issued in NJ

Practice address

3 Industrial Way E
Eatontown, NJ 07724-3318

Phone

(732) 544-1557

NPI assigned

Mar 9, 2023

Last updated

Mar 9, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Brooke R Sousie Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1144920919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E ELM AVE",
            "city": "GALLOWAY",
            "state": "NJ",
            "postal_code": "082059713",
            "telephone_number": "518-944-1670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 INDUSTRIAL WAY E",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077243318",
            "telephone_number": "732-544-1557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKITICH",
        "first_name": "BROOKE",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-09",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NJ",
            "license": "46TA09150500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "SOUSIE",
            "middle_name": "R",
            "prefix": "MS.",
            "credential": "COTA/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapy Assistant in Eatontown, NJ
• Providers in Eatontown, NJ by specialty
• Occupational Therapy Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.