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General NPI Number Information
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NPI Number | 1093223182
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Entity Type | Individual
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Provider Name | TIM RAY BROCKETT
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Gender | Male
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Dates
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Enumeration Date | 01/11/2018
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 56 S MAIN ST
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City | CROSSVILLE
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State | TN
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Zip | 38555-4520
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Country | US
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Telephone | 440-812-2853
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Fax | 931-707-9474
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Provider Business Mailing Address
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Address Line | 56 S MAIN ST
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City | CROSSVILLE
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State | TN
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Zip | 38555-4520
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Country | US
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Telephone | 440-812-2853
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA16207
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT22381
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 7758
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License Number State | TN
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