MEDICARE: REGINA BROCK-HUFF OTR

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	225XH1200X	Hand Occupational Therapist	OT003699	GA

General Provider Information

NPI Number	:	1528251345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA BROCK-HUFF OTR

Provider Business Mailing Address
First Line	:	1819 PEACHTREE RD NE
Second Line	:	SUITE 425
City	:	ATLANTA
State	:	GA
Zip	:	30309-1848
Country	:	US
Telephone Number	:	404-352-3522
Fax Number	:	404-601-1235

Provider Business Practice Location Address
First Line	:	1819 PEACHTREE RD NE
Second Line	:	SUITE 425
City	:	ATLANTA
State	:	GA
Zip	:	30309-1848
Country	:	US
Telephone Number	:	404-352-3522
Fax Number	:	404-601-1235

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

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	08/24/2007

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