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NPI Code Detail

MEDICARE: SAMUEL ELI BROOKOVER MOTR/L

MEDICARE: SAMUEL ELI BROOKOVER MOTR/L
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
1225X00000XOccupational Therapist2080WV

General Provider Information

NPI Number : 1740826064
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL ELI BROOKOVER MOTR/L
Provider Business Mailing Address
First Line : 2991 DOOLIN RUN RD
Second Line :
City : NEW MARTINSVILLE
State : WV
Zip : 26155-7830
Country : US
Telephone Number : 304-455-5901
Fax Number :
Provider Business Practice Location Address
First Line : 1000 MAPLEWOOD DR
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-9115
Country : US
Telephone Number : 304-848-0200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2019
Last Update Date : 11/21/2019

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Directions to “ SAMUEL ELI BROOKOVER MOTR/L” Practice Location

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