Provider Demographics
NPI:1437230703
Name:BROOKE, LLEWELLA (OT)
Entity Type:Individual
Prefix:
First Name:LLEWELLA
Middle Name:
Last Name:BROOKE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LLEWELLA
Other - Middle Name:
Other - Last Name:BESTROP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:520 FRANCISCO DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-2723
Mailing Address - Country:US
Mailing Address - Phone:650-331-3700
Mailing Address - Fax:
Practice Address - Street 1:299 S CALIFORNIA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1935
Practice Address - Country:US
Practice Address - Phone:650-331-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1152225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23021ZMedicare ID - Type Unspecified