MEDICARE: ADAM M HOLBROOK OTR/L, CHT

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	18882	NY
2	225XH1200X	Hand Occupational Therapist	4307	CA

General Provider Information

NPI Number	:	1629487244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM M HOLBROOK OTR/L, CHT

Provider Business Mailing Address
First Line	:	PO BOX 897
Second Line	:
City	:	SOQUEL
State	:	CA
Zip	:	95073-0897
Country	:	US
Telephone Number	:	510-610-9056
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 MADRONE ST
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-2714
Country	:	US
Telephone Number	:	831-457-7057
Fax Number	:

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

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	07/17/2022

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