Provider Demographics
NPI:1811686967
Name:MULLENDORE, BROOKE ALEXA (OTR/L, OTD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ALEXA
Last Name:MULLENDORE
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:ALEXA
Other - Last Name:RIEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, OTD
Mailing Address - Street 1:105 SW EAGLES PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-8512
Mailing Address - Country:US
Mailing Address - Phone:816-526-5117
Mailing Address - Fax:816-443-5692
Practice Address - Street 1:105 SW EAGLES PKWY
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-8512
Practice Address - Country:US
Practice Address - Phone:816-526-5117
Practice Address - Fax:816-443-5692
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist