Provider Demographics
NPI:1033160155
Name:BARKLEY, BROOKE E (OT)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:E
Last Name:BARKLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:E
Other - Last Name:KISSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-0922
Mailing Address - Country:US
Mailing Address - Phone:866-309-5567
Mailing Address - Fax:812-491-1269
Practice Address - Street 1:515 READ ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1739
Practice Address - Country:US
Practice Address - Phone:812-437-1420
Practice Address - Fax:812-437-1425
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004577A225X00000X
SC2927225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000598396OtherBLUE CROSS BLUE SHIELD
IN000000601777OtherBLUE CROSS BLUE SHIELD
IN200951470Medicaid
IN352071262004OtherTRICARE
IN352071262004OtherTRICARE
SCQ341506071Medicare PIN
IN200951470Medicaid