Provider Demographics
NPI:1477105534
Name:LANGE, BROOKE (OTR/L)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BASSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BURTRUM
Mailing Address - State:MN
Mailing Address - Zip Code:56318-1038
Mailing Address - Country:US
Mailing Address - Phone:320-630-3215
Mailing Address - Fax:
Practice Address - Street 1:209 ASH ST E
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:MN
Practice Address - Zip Code:55302-3148
Practice Address - Country:US
Practice Address - Phone:320-274-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist