Active NPI
Constance Marie Brake, MS OTRL
- Occupational Therapist
- Greensboro, NC
National Provider Identifier
1407913627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4237
- Practice address
- 5415 W Friendly Ave Ste a
Greensboro, NC 27410-4255 - Phone
- (336) 772-5499
- Fax
- (336) 292-6064
- NPI assigned
- Jan 3, 2007
- 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 | 4237 | NC | Primary |
Addresses
Primary practice location
5415 W Friendly Ave Ste a
Greensboro, NC 27410-4255
Mailing address
130 Park Boulevard
Winston Salem, NC 27127-2042
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13740 | Other | NC | BLUE CROSS AND BLUE SHIEL |
| 7301713 | Medicaid | NC |
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 |
|---|---|---|---|
| 4237 | NC | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Interact Pediatric Therapy Services, PLLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Speech-Language Pathologist
- Greensboro, NC
- NPI 1740505346
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309996800000",
"number": "1407913627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 PARK BOULEVARD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271272042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5415 W FRIENDLY AVE STE A",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274104255",
"telephone_number": "336-772-5499",
"fax_number": "336-292-6064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAKE",
"first_name": "CONSTANCE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "MS OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-03",
"last_updated": "2011-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "4237",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS AND BLUE SHIEL",
"identifier": "13740",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7301713",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.