Provider Demographics
NPI:1386264471
Name:CLEVEN, BROOKE ERIN (OTR/L)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ERIN
Last Name:CLEVEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 AVERY RANCH BLVD APT 717
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1695
Mailing Address - Country:US
Mailing Address - Phone:512-663-3977
Mailing Address - Fax:
Practice Address - Street 1:12600 AVERY RANCH BLVD APT 717
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1695
Practice Address - Country:US
Practice Address - Phone:512-663-3977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120307225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist