Healthcare Provider Details

I. General information

NPI: 1598508533
Provider Name (Legal Business Name): BROOKE MARSHALL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14715 BRISTOL PARK BLVD
EDMOND OK
73013-1894
US

IV. Provider business mailing address

2216 HIDDEN PRAIRIE WAY
EDMOND OK
73013-5967
US

V. Phone/Fax

Practice location:
  • Phone: 405-840-1686
  • Fax:
Mailing address:
  • Phone: 417-619-4308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5960
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: