Individual
MIKAELA JADE BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2776 JANITELL RD, COLORADO SPRINGS, CO 80906-4103
(719) 332-4689
Mailing address
6077 MUMFORD DR, COLORADO SPRINGS, CO 80925-8472
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT.0007579
CO
Other
Enumeration date
06/01/2023
Last updated
06/01/2023
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