Active NPI
Michele Brockway, MS, OTR/L
- Occupational Therapist
- St Augustine, FL
National Provider Identifier
1174909386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT 8068
- Practice address
- 2836 Sheephead CT
St Augustine, FL 32092-2441 - Phone
- (843) 697-6874
- NPI assigned
- Aug 11, 2015
- 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 | OT 8068 | FL | Primary |
Addresses
Primary practice location
2836 Sheephead CT
St Augustine, FL 32092-2441
Mailing address
2836 Sheephead CT
St Augustine, FL 32092-2441
Phone (843) 697-6874
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OT 8068 | Other | FL | OT LICENSE |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT 8068 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439251200000",
"number": "1174909386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2836 SHEEPHEAD CT",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320922441",
"telephone_number": "843-697-6874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2836 SHEEPHEAD CT",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320922441",
"telephone_number": "843-697-6874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCKWAY",
"first_name": "MICHELE",
"name_prefix": "Mrs.",
"credential": "MS, OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-11",
"last_updated": "2015-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT 8068",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OT LICENSE",
"identifier": "OT 8068",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.