MEDICARE: KRISTEN MARIE BROKAMP OTR/L

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
1	225X00000X	Occupational Therapist	OT009258	OH

General Provider Information

NPI Number	:	1912367624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN MARIE BROKAMP OTR/L

Provider Business Mailing Address
First Line	:	2234 KEMPER LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2719
Country	:	US
Telephone Number	:	513-518-3194
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 IDA AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-4213
Country	:	US
Telephone Number	:	513-549-2128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2016
Last Update Date	:	05/30/2023

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