Justin Brazeal, MS, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OTR2546 Issued in AR

Practice address

1301 Russell Rd
Russellville, AR 72802-4320

Phone

(479) 967-2316

Fax

(479) 967-3639

NPI assigned

Sep 11, 2012

Last updated

Jan 31, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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.

• Ascent Acquisitions Corp-PSC

  dba Pediatric Specialty Care

  • Speech-Language Pathologist
  • North Little Rock, AR
  • NPI 1336271659
  NPD (past)
• Friendship Community Care Inc.

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Russellville, AR
  • NPI 1528144318
  NPD (past)

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

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1366792079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. DRAWER 2109",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "72811",
            "telephone_number": "479-967-2322",
            "fax_number": "479-967-2876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 RUSSELL RD",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728024320",
            "telephone_number": "479-967-2316",
            "fax_number": "479-967-3639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAZEAL",
        "first_name": "JUSTIN",
        "credential": "MS, OTR/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-11",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AR",
            "license": "OTR2546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194197721",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Michelle Branch, NP
• Mariya Branch
• Kelly Braton
• Meghan Kerin Bratton, MD
• Willie Braxton
• Caitlyn J Brazil, OTD, OTR/L
• Abigail Breer
• Clifford G Breier, CRNA
• Candace Dawn Brewer, LAC
• Jenna Brewer, DPT

• Occupational Therapist in Russellville, AR
• Providers in Russellville, AR by specialty
• Occupational Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; 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.