Basic Information
Provider Information
NPI: 1003003567
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REDMAN
FirstName: BROOKE
MiddleName: HALLIE
NamePrefix: MS.
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8333 CLAIREMONT MESA BLVD
Address2: SUITE 203
City: SAN DIEGO
State: CA
PostalCode: 921111318
CountryCode: US
TelephoneNumber: 8582688585
FaxNumber: 8582685729
Practice Location
Address1: 8333 CLAIREMONT MESA BLVD
Address2: SUITE 203
City: SAN DIEGO
State: CA
PostalCode: 921111318
CountryCode: US
TelephoneNumber: 8582688585
FaxNumber: 8582685729
Other Information
ProviderEnumerationDate: 09/28/2007
LastUpdateDate: 01/31/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X1070985CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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