Nicholas Colby Brock, OTR/L

Key facts

NPI

1639738719

Entity type

Individual (NPI type 1)

Primary specialty

Occupational Therapist 225X00000X

License

5558 (SC)

Practice address

4015 2ND Ave Ste B
Summerville, SC 29486-7882

Phone

(843) 376-3996

NPI assigned

Jun 11, 2019

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 11, 2019.

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1639738719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 CENTRAL ISLAND ST UNIT 459",
            "city": "DANIEL ISLAND",
            "state": "SC",
            "postal_code": "294926806",
            "telephone_number": "703-987-7283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4015 2ND AVE STE B",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294867882",
            "telephone_number": "843-376-3996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "NICHOLAS",
        "middle_name": "COLBY",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-11",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": "5558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, SC

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• Thearica L Bright-Mickle, LPC
• Billy Wayne Brigman, L.M.T.
• Yvonne Britt-Miller
• Broad River Physicians Group, LLC
• Robert T Brockhouse, D.D.S.
• Ashley Kay Brodrick, DO
• Maureen Louise Brogan, CCC-SLP
• Allie Michelle Brooks, DNP
• Todd V Brooks, PT

All providers in Summerville, SC · Occupational Therapist in South Carolina