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Individual

BROOKLYNN MAE NORTHERN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTD

Contact information

Practice address
982 EASTERN PKWY, LOUISVILLE, KY 40217-1566
(502) 635-6397
Mailing address
304 JACKSON WAY, CHARLESTOWN, IN 47111-0030

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
289403
KY

Other

Enumeration date
09/28/2023
Last updated
05/07/2024
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