Individual
MISS BROOKE SHEREE BACKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L, RYT
Contact information
Practice address
111 E MAIN ST, ST CHARLES, IL 60174-1948
(312) 841-0993
Mailing address
1921 W WILSON ST, BATAVIA, IL 60510-3194
(312) 841-0993
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
056.007942
IL
Other
Enumeration date
01/10/2007
Last updated
06/04/2013
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