Provider Demographics
NPI:1962082511
Name:BREKKE, ANNA ELIZABETH (COTA/L)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ELIZABETH
Last Name:BREKKE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-4671
Mailing Address - Country:US
Mailing Address - Phone:630-485-1393
Mailing Address - Fax:
Practice Address - Street 1:750 PASQUINELLI DR STE 204
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1291
Practice Address - Country:US
Practice Address - Phone:630-560-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.005558224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant