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General NPI Number Information
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NPI Number | 1063937969
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Entity Type | Individual
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Provider Name | BROOKE JOYCE PRILLAMAN MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/11/2017
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Last Update Date | 08/11/2017
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Provider Practice Location Address
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Address Line | 812 E CHURCH ST
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City | MARTINSVILLE
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State | VA
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Zip | 24112-3109
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Country | US
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Telephone | 276-638-4890
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Fax | 276-638-5139
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Provider Business Mailing Address
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Address Line | 110 FAIRVIEW DR
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City | BASSETT
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State | VA
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Zip | 24055-6010
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Country | US
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Telephone | 276-734-0205
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 0119-007432
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License Number State | VA
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