Provider Demographics
NPI:1659444628
Name:REILLY, BROOKE MEREDITH (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:MEREDITH
Last Name:REILLY
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 1:41 PINE GROVE ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1714
Mailing Address - Country:US
Mailing Address - Phone:617-775-0213
Mailing Address - Fax:
Practice Address - Street 1:44 MECHANIC ST STE 205
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1474
Practice Address - Country:US
Practice Address - Phone:617-775-0213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist