Healthcare Provider Details

I. General information

NPI: 1508250325
Provider Name (Legal Business Name): BROOKE MELANIE HULLETT OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE INGLE

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8024 GLEASON DR
KNOXVILLE TN
37919-5586
US

IV. Provider business mailing address

3243 HERITAGE CIR
HENDERSONVILLE NC
28791-3553
US

V. Phone/Fax

Practice location:
  • Phone: 865-406-7129
  • Fax: 865-951-7273
Mailing address:
  • Phone: 828-713-0560
  • Fax: 865-951-7273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5189
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: