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NPI Code Detail

MEDICARE: BROOKE TANKLEFF

MEDICARE: BROOKE TANKLEFF
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist15896FL
2225X00000XOccupational Therapist115931TX

General Provider Information

NPI Number : 1144652439
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE TANKLEFF
Provider Business Mailing Address
First Line : 416 HARROLD ST APT 1117
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-2355
Country : US
Telephone Number : 954-647-2860
Fax Number :
Provider Business Practice Location Address
First Line : 416 HARROLD ST APT 1117
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-2355
Country : US
Telephone Number : 954-647-2860
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2013
Last Update Date : 09/10/2018

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Directions to “ BROOKE TANKLEFF ” Practice Location

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