Provider Demographics
NPI:1760148605
Name:GILBERTSON, BROOKE (OTR/L, MOT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:GILBERTSON
Suffix:
Gender:F
Credentials:OTR/L, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 BROOKDALE RD APT 22
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-0409
Mailing Address - Country:US
Mailing Address - Phone:608-341-8264
Mailing Address - Fax:
Practice Address - Street 1:396 REMINGTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4311
Practice Address - Country:US
Practice Address - Phone:630-312-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014479225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist