Provider Demographics
NPI:1336168376
Name:SAUER, BROOKE M (OT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:M
Last Name:SAUER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5244
Mailing Address - Fax:740-446-5448
Practice Address - Street 1:1051 4TH AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631
Practice Address - Country:US
Practice Address - Phone:740-446-5244
Practice Address - Fax:740-446-5448
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.003840225X00000X
SC4367225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0555340OtherMOLINA MEDICAID
000000217244OtherANTHEM BCBS
670001493OtherRR MEDICARE
000000204793OtherOH MEDICAID UNISON
OH3058935Medicaid
310917085176OtherOHIO MEDICAID CARESOURCE
001714137OtherMOUNTAIN STATE BCBS
WV0159613000Medicaid
OH0555340OtherMOLINA MEDICAID