Provider Demographics
NPI:1609419688
Name:UMFLEET, BROOKE ASHLEY
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ASHLEY
Last Name:UMFLEET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 11470
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:MO
Mailing Address - Zip Code:63956-8712
Mailing Address - Country:US
Mailing Address - Phone:573-225-7174
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 11470
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:MO
Practice Address - Zip Code:63956-8712
Practice Address - Country:US
Practice Address - Phone:573-225-7174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018005494225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
397178OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY