Healthcare Provider Details

I. General information

NPI: 1578186029
Provider Name (Legal Business Name): BROOKE ANN SUMERIX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 S MAIN ST
CHEBOYGAN MI
49721-2220
US

IV. Provider business mailing address

2182 VANYEA RD
CHEBOYGAN MI
49721-8903
US

V. Phone/Fax

Practice location:
  • Phone: 231-627-1368
  • Fax:
Mailing address:
  • Phone: 989-255-2790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5201010898
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: