Provider Demographics
NPI:1376866806
Name:HANVEY, BROOKE NICOLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:NICOLE
Last Name:HANVEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:BROOKE
Other - Middle Name:NICOLE
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 2101
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63158-0101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 GERRI ANN DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-3151
Practice Address - Country:US
Practice Address - Phone:618-977-9148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008903225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist