Provider Demographics
NPI:1891027835
Name:DANFORTH, BROOKE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:DANFORTH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:ONDERLINDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57743 NICOLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48048-3310
Mailing Address - Country:US
Mailing Address - Phone:269-501-6228
Mailing Address - Fax:
Practice Address - Street 1:44201 DEQUINDRE RD STE 203A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1117
Practice Address - Country:US
Practice Address - Phone:248-964-4014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004825A225X00000X
MI5201007723225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist