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General NPI Number Information
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NPI Number | 1124751458
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Entity Type | Individual
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Provider Name | BROOKE MCMILLAN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 6135 WILLIAMS RD
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City | TALLAHASSEE
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State | FL
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Zip | 32311-9107
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Country | US
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Telephone | 850-294-9716
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Fax | 888-604-2089
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Provider Business Mailing Address
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Address Line | 1405 SOUTHWOOD PLANTATION RD APT 4206
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City | TALLAHASSEE
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State | FL
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Zip | 32311-4221
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Country | US
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Telephone | 980-355-4486
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 23309
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License Number State | FL
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