Active NPI
John Broome II, COTA/L
- Occupational Therapy Assistant
- Trinity, NC
National Provider Identifier
1568802437
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 8726
- Practice address
- 116 Lane Dr
Trinity, NC 27370-9343 - Phone
- (336) 431-8888
- NPI assigned
- Jun 25, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 Therapy Assistant | 224Z00000X | 8726 | NC | Primary |
Addresses
Primary practice location
116 Lane Dr
Trinity, NC 27370-9343
Mailing address
136 Mackwood Rd
Mooresville, NC 28115-7819
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8726 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372118400000",
"number": "1568802437",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "136 MACKWOOD RD",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281157819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "116 LANE DR",
"city": "TRINITY",
"state": "NC",
"postal_code": "273709343",
"telephone_number": "336-431-8888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOME",
"first_name": "JOHN",
"name_suffix": "II",
"credential": "COTA/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-06-25",
"last_updated": "2013-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NC",
"license": "8726",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Trinity, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.