Active NPI
Brook Antonson, OTR/L
- Occupational Therapist
- South Haven, MI
National Provider Identifier
1982107009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201010018
- Practice address
- 04915 64TH St
South Haven, MI 49090-7323 - Phone
- (269) 929-5764
- NPI assigned
- Mar 15, 2018
- 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 | 5201010018 | MI | Primary |
Addresses
Primary practice location
04915 64TH St
South Haven, MI 49090-7323
Mailing address
04915 64TH St
South Haven, MI 49090-7323
Other names 1
- Brook Krall
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 |
|---|---|---|---|
| 5201010018 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714435200000",
"number": "1982107009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "04915 64TH ST",
"city": "SOUTH HAVEN",
"state": "MI",
"postal_code": "490907323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "04915 64TH ST",
"city": "SOUTH HAVEN",
"state": "MI",
"postal_code": "490907323",
"telephone_number": "269-929-5764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTONSON",
"first_name": "BROOK",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-15",
"last_updated": "2024-04-30",
"certification_date": "2024-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201010018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BROOK",
"last_name": "KRALL",
"code": "1",
"type": "Former Name"
}
]
}Other providers in South Haven, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.