Holly Suzanne Brake, O.T.R., C.H.T.
Individual provider Active NPI Occupational Therapist · Jasper, IN
NPI 1235440660 · NPPES record last updated Sep 24, 2010
Key facts
- NPI
- 1235440660
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 31001714A (IN)
- Practice address
- 1900 Saint Charles St
Jasper, IN 47546-9145 - Phone
- (812) 634-1211
- NPI assigned
- Jun 30, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31001714A | IN | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indiana University Health Southern Indiana Physicians, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 31001714A | IN | Yes |
Addresses
Primary practice location
1900 Saint Charles St
Jasper, IN 47546-9145
Mailing address
908 Clay St
Jasper, IN 47546-2804
Phone (812) 219-2967
Other providers in Jasper, IN
- Hilary Brehan Bonilla
- Hope Borden
- Jennifer Bowlds
- Leah Boze
- Bra Company LLC
- Allison Lea Braun
- Margaret Faith Brawley
- Alyssa Breitwieser
- Rose Bright
- Brookside Village, Inc
All providers in Jasper, IN · Occupational Therapist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.