Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Brooke Southivong

Individual provider Occupational Therapy Assistant · NPI 1467887406

Brooke Southivong is an Occupational Therapy Assistant in Fort Wayne, Indiana. Licensed in Indiana. Registered with an NPI since 2013.

Licensed in
IN
In the registry since
2013

Practice location Address checks out

884 Beal Brook Pass
Fort Wayne, IN 46814-8236
Phone: (260) 479-0828
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapy Assistant (primary) Taxonomy 224Z00000X · Licence 32002424A (IN)

Record details

NPI number1467887406
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedSeptember 10, 2013
Last updated in NPPESFebruary 20, 2014

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