Provider Demographics
NPI:1558659243
Name:POTURALLSKI, BROOKE A (OT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:POTURALLSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 LUCERNE DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6588
Mailing Address - Country:US
Mailing Address - Phone:419-841-1840
Mailing Address - Fax:418-841-1841
Practice Address - Street 1:3160 CENTRAL PARK W
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1083
Practice Address - Country:US
Practice Address - Phone:419-841-1840
Practice Address - Fax:419-841-1841
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT007820225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist