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1215043575 NPI number — CHARLES ARTHUR BROCKINGTON OTR

NPI Number: 1215043575
Health Care Provider/Practitioner: CHARLES ARTHUR BROCKINGTON OTR

Information about “1215043575” NPI (CHARLES ARTHUR BROCKINGTON OTR) exists in 1215043575 in HTML format HTML  |  1215043575 in plain Text format TXT  |  1215043575 in PDF (Portable Document Format) PDF  |  1215043575 in an XML format XML  formats.

NPI Number : 1215043575 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215043575",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROCKINGTON",
    "FirstName": "CHARLES",
    "MiddleName": "ARTHUR",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "OTR",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BROCKINGTON",
    "OtherFirstName": "CHARLES",
    "OtherMiddleName": "ARTHUR",
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": null,
    "OtherCredential": "OTR",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1729 W JEFFERSON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WESLACO",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78596-4356",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "956-532-8871",
    "MailingAddressFaxNumber": "956-973-8972",
    "FirstLinePracticeLocationAddress": "4412 N MCCOLL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MCALLEN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78504-2480",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "956-973-8972",
    "PracticeLocationAddressFaxNumber": "956-973-8972",
    "EnumerationDate": "08/21/2006",
    "LastUpdateDate": "07/09/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225X00000X",
        "TaxonomyName": "Occupational Therapist",
        "LicenseNumber": "111342",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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