Provider Demographics
NPI:1407530785
Name:HUPP, BROOKLYN KAE (OTD)
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:KAE
Last Name:HUPP
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:BROOKLYN
Other - Middle Name:KAE
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:3901 W NORFOLK AVE STE P
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-9501
Mailing Address - Country:US
Mailing Address - Phone:402-371-9026
Mailing Address - Fax:402-371-0807
Practice Address - Street 1:3901 W NORFOLK AVE STE P
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-9501
Practice Address - Country:US
Practice Address - Phone:402-371-9026
Practice Address - Fax:402-371-0807
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2790225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist