Philusa Chua McBroom, OTDR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT005932 Issued in GA

Practice address

100B Lindsey Lane
Kingsland, GA 31548

Phone

(912) 510-6104

Fax

(912) 882-6137

NPI assigned

Oct 9, 2013

Last updated

Jun 17, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Philusa Chua Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Cobblestone Pathways, LLC

  dba Cobblestone Therapy Group

  • Speech-Language Pathologist
  • Roswell, GA
  • NPI 1528171535
  NPD (past)

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

{
    "created_epoch": "1381276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402963200000",
    "number": "1265869184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100B LINDSEY LANE",
            "city": "KINGSLAND",
            "state": "GA",
            "postal_code": "31548",
            "telephone_number": "912-510-6104",
            "fax_number": "912-882-6137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100B LINDSEY LANE",
            "city": "KINGSLAND",
            "state": "GA",
            "postal_code": "31548",
            "telephone_number": "912-510-6104",
            "fax_number": "912-882-6137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUA MCBROOM",
        "first_name": "PHILUSA",
        "credential": "OTDR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-09",
        "last_updated": "2014-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "15996",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT005932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHILUSA",
            "last_name": "CHUA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Camden Women's Center
• Misty Shay Campbell
• Amber Makayla Carver
• Mallory Chappell, APRN
• Charlton Family Care, Inc
• Noel N Chua, MD
• Jose Enrique Cintron
• City of Kingsland (Kingsland Fire Rescue)
• Ryan Manning Clements
• Lauren Mary-Marie Cleveland, FNP

• Occupational Therapist in Kingsland, GA
• Providers in Kingsland, GA by specialty
• Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.