Provider Demographics
NPI:1144613217
Name:ENSING, BROOKE (MS, OTRL)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:ENSING
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 MUNSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3097
Mailing Address - Country:US
Mailing Address - Phone:231-946-7700
Mailing Address - Fax:231-946-8507
Practice Address - Street 1:328 MUNSON AVE STE A
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3097
Practice Address - Country:US
Practice Address - Phone:231-946-7700
Practice Address - Fax:231-946-8507
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009065225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist