Larry B Brazell

Individual provider Active NPI Occupational Therapy Assistant · Mauldin, SC

NPI 1790718294 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1790718294
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
2281 (SC)
Practice address
213 E Butler Rd BLDG E2
Mauldin, SC 29662-2172
Phone
(864) 984-0832
Fax
(678) 840-2112
NPI assigned
Jul 8, 2006
Sex
Female
Sole proprietor
No

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Cortina Consultants, Inc. Occupational Therapy Assistant Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 2281 SC Yes

Addresses

Primary practice location

213 E Butler Rd BLDG E2
Mauldin, SC 29662-2172

Mailing address

PO Box 369
Simpsonville, SC 29681-0369
Phone (864) 201-4301

Other providers in Mauldin, SC

All providers in Mauldin, SC · Occupational Therapy Assistant in South Carolina

Sources for this page

Verify at the official NPI Registry.