Individual
BROOKE TANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
325 E FLORIDA AVE, APPLETON, WI 54911-1325
(920) 731-7310
Mailing address
301 S MAIN ST, BLACK CREEK, WI 54106-9518
(920) 419-1095
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
302705
WI
224Z00000X
Occupational Therapy Assistant
4973-27
WI
Other
Enumeration date
08/06/2013
Last updated
12/14/2020
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