Individual
DEZARAY NICOLE BROOKSHIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
668 700TH ST, ELKHART, IL 62634-6055
(217) 273-5345
Mailing address
668 700TH ST, ELKHART, IL 62634-6055
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
01/20/2022
Last updated
01/20/2022
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