Healthcare Provider Details

I. General information

NPI: 1366922999
Provider Name (Legal Business Name): BROOKE ANGELIQUE RECKER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 N PALMYRA RD
CANFIELD OH
44406-9709
US

IV. Provider business mailing address

7742 PEGOTTY DR NE
WARREN OH
44484-1482
US

V. Phone/Fax

Practice location:
  • Phone: 330-533-8755
  • Fax:
Mailing address:
  • Phone: 330-307-4337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT010290
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: