MEDICARE: BROOKE C RISNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0119006229	VA

General Provider Information

NPI Number	:	1487071221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE C RISNEY

Provider Business Mailing Address
First Line	:	4560 SOUTH BLVD STE 310
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1160
Country	:	US
Telephone Number	:	757-490-3223
Fax Number	:	757-490-2936

Provider Business Practice Location Address
First Line	:	4560 SOUTH BLVD STE 310
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1160
Country	:	US
Telephone Number	:	757-490-3223
Fax Number	:	757-490-2936

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2014
Last Update Date	:	04/13/2026

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