Provider Demographics
NPI:1992522841
Name:TUNNELL, BROOKE MACKENZIE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:MACKENZIE
Last Name:TUNNELL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9840 CARTA LN
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-2503
Mailing Address - Country:US
Mailing Address - Phone:619-929-9685
Mailing Address - Fax:
Practice Address - Street 1:6977 NAVAJO RD STE 455
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1503
Practice Address - Country:US
Practice Address - Phone:858-848-9917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24594225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics