Provider Demographics
NPI:1790997849
Name:GREINER, BROOKE MARIE (MS, OTR)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:MARIE
Last Name:GREINER
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6218
Mailing Address - Country:US
Mailing Address - Phone:206-595-5245
Mailing Address - Fax:206-632-0990
Practice Address - Street 1:2134 N 52ND ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6218
Practice Address - Country:US
Practice Address - Phone:206-595-5245
Practice Address - Fax:206-632-0990
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000780225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7127038Medicaid