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General NPI Number Information
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NPI Number | 1396445540
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Entity Type | Individual
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Provider Name | EMILY LAUREN BROYLES OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 175 DEER RUN RD
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City | DANVILLE
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State | VA
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Zip | 24540-2863
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Country | US
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Telephone | 434-797-5531
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Fax | 434-797-5529
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Provider Business Mailing Address
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Address Line | 1665 WHITMELL SCHOOL RD
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City | DRY FORK
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State | VA
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Zip | 24549-3827
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Country | US
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Telephone | 434-203-0970
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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 | 0119009842
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License Number State | VA
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