Provider Demographics
NPI:1598437725
Name:IKE, EMIL BROW (OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:EMIL
Middle Name:BROW
Last Name:IKE
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 RUSSELL ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-3534
Mailing Address - Country:US
Mailing Address - Phone:413-341-6441
Mailing Address - Fax:
Practice Address - Street 1:234 RUSSELL ST STE 201
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-3534
Practice Address - Country:US
Practice Address - Phone:413-341-6441
Practice Address - Fax:413-200-3280
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14037225X00000X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist