Provider Demographics
NPI:1295495836
Name:MAYER, BROOKE (MOTR/L)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MAYER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7803 W 159TH ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1343
Mailing Address - Country:US
Mailing Address - Phone:708-719-4288
Mailing Address - Fax:708-840-7153
Practice Address - Street 1:7803 W 159TH ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1343
Practice Address - Country:US
Practice Address - Phone:708-719-4288
Practice Address - Fax:708-840-7153
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist