Healthcare Provider Details

I. General information

NPI: 1316968514
Provider Name (Legal Business Name): BROOKE J BROOKS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE J GAFF OTR/L

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 LAPORTE AVE SUITE 5
VALPARAISO IN
46383-6996
US

IV. Provider business mailing address

1 WESTBROOK CORPORATE CTR STE 240
WESTCHESTER IL
60154-5745
US

V. Phone/Fax

Practice location:
  • Phone: 219-477-4500
  • Fax:
Mailing address:
  • Phone: 708-236-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31003726A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056008033
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: