Active NPI
Brooke Alise Wells, OTD, OTR/L
- Occupational Therapist
- Summit, MS
National Provider Identifier
1275216228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4053
- Practice address
- 4109 Highway 98 W
Summit, MS 39666-9132 - Phone
- (601) 276-3900
- NPI assigned
- Aug 8, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 4053 | MS | Primary |
Addresses
Primary practice location
4109 Highway 98 W
Summit, MS 39666-9132
Mailing address
1143 Deer Creek LN
Summit, MS 39666-5612
Phone (601) 249-7002
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4053 | MS | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691452800000",
"number": "1275216228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1143 DEER CREEK LN",
"city": "SUMMIT",
"state": "MS",
"postal_code": "396665612",
"telephone_number": "601-249-7002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4109 HIGHWAY 98 W",
"city": "SUMMIT",
"state": "MS",
"postal_code": "396669132",
"telephone_number": "601-276-3900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLS",
"first_name": "BROOKE",
"middle_name": "ALISE",
"name_prefix": "Dr.",
"credential": "OTD, OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-08",
"last_updated": "2023-08-08",
"certification_date": "2023-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MS",
"license": "4053",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summit, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.