Healthcare Provider Details

I. General information

NPI: 1336311109
Provider Name (Legal Business Name): BROOKE DANIELLE SHIRER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 W LINCOLN HIGHWAY US ROUTE 30
SCHERERVILLE IN
46375-0000
US

IV. Provider business mailing address

205 W WACKER DR SUITE 1020
CHICAGO IL
60606-1216
US

V. Phone/Fax

Practice location:
  • Phone: 219-865-1436
  • Fax: 219-865-1787
Mailing address:
  • Phone: 312-640-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number99031023A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31004616A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: