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General NPI Number Information
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NPI Number | 1295244036
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Entity Type | Individual
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Provider Name | BROOKE IDELL CZULEGER OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 09/25/2017
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Provider Practice Location Address
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Address Line | 412 RED HILL AVE STE 1
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City | SAN ANSELMO
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State | CA
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Zip | 94960-2468
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Country | US
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Telephone | 805-698-1262
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 CALLE FRESNO
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City | SANTA BARBARA
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State | CA
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Zip | 93105-2737
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Country | US
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Telephone | 805-698-1262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT17805
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License Number State | CA
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