Provider Demographics
NPI:1245708858
Name:BATEMAN, BROOKE KELLY (MA)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:KELLY
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 JANET DR
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-3078
Mailing Address - Country:US
Mailing Address - Phone:440-265-8803
Mailing Address - Fax:
Practice Address - Street 1:2026 OH-45
Practice Address - Street 2:
Practice Address - City:AUSTINBURG
Practice Address - State:OH
Practice Address - Zip Code:44010
Practice Address - Country:US
Practice Address - Phone:440-275-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist