Provider Demographics
NPI:1891435483
Name:KONECHNE, BROOKE W (OTR//L)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:W
Last Name:KONECHNE
Suffix:
Gender:F
Credentials:OTR//L
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:W
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2129
Mailing Address - Country:US
Mailing Address - Phone:605-334-5630
Mailing Address - Fax:605-332-5327
Practice Address - Street 1:100 W HWY 38
Practice Address - Street 2:SUITE H
Practice Address - City:HARTFORD
Practice Address - State:SD
Practice Address - Zip Code:57033
Practice Address - Country:US
Practice Address - Phone:605-528-1900
Practice Address - Fax:605-528-1901
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist