Healthcare Provider Details

I. General information

NPI: 1326903584
Provider Name (Legal Business Name): OLIVIA BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W 26TH ST
ST LOUIS PARK MN
55426-3357
US

IV. Provider business mailing address

14080 37TH PL N
PLYMOUTH MN
55447-5406
US

V. Phone/Fax

Practice location:
  • Phone: 952-928-6600
  • Fax:
Mailing address:
  • Phone: 763-218-6667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number105448
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: