Individual
BROOKE LAUREN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1401 CAMPUS DR, CLIVE, IA 50325-6500
(515) 381-6519
Mailing address
2417 71ST ST, URBANDALE, IA 50322-4862
(404) 862-5855
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
101624
IA
225X00000X
Occupational Therapist
278756
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101624
IOWA BOARD OF OCCUPATIONAL AND PHYSICAL THERAPY
IA
01
—
278756
KENTUCKY BOARD OF OCCUPATIONAL THERAPY
KY
Enumeration date
07/18/2022
Last updated
07/18/2022
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