Individual provider Active NPI

Brooke Colburn, OTR/L

  • Occupational Therapist
  • Atlanta, GA
National Provider Identifier
1083018329
Registry record updated Oct 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
000771 Issued in GA
Practice address
8592 Roswell Rd
Atlanta, GA 30350-1865
Phone
(706) 869-4501
NPI assigned
Oct 15, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 000771 GA Primary

Addresses

Primary practice location

8592 Roswell Rd
Atlanta, GA 30350-1865

Mailing address

8592 Roswell Road
Atlanta, GA 30350
Phone (706) 869-4501

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190506001224 GA Practitioner - Occupational Therapist in Private Practice 6507108909 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
000771GAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Therapy LLC CurrentSince Apr 1, 2019 Accepting new patients
Functional Pathways Preferred of Tennessee LLC Occupational Therapist CurrentSince Aug 10, 2020 Accepting new patients
Life Clinic of Ga PC PastSince Feb 7, 2022 Accepting new patients

Locations

855 North Point Pkwy
Alpharetta, GA 30005
Phone (952) 401-2336

2221 Peachtree Rd NE
Ste D336
Atlanta, GA 30309

355 S River St
Calhoun, GA 30701

5600 Roswell Rd
Bldg I
Sandy Springs, GA 30342
Phone (404) 303-2323

14200 Highway 92
Woodstock, GA 30188
Phone (677) 819-7658

10133 Sherrill Blvd
Ste 200
Knoxville, TN 37932
Phone (865) 392-2847

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413331200000",
    "number": "1083018329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8592 ROSWELL ROAD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30350",
            "telephone_number": "706-869-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8592 ROSWELL RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303501865",
            "telephone_number": "706-869-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLBURN",
        "first_name": "BROOKE",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-15",
        "last_updated": "2014-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "000771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.