=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508672445
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BROOKE SECHLER OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2024
-----------------------------------------------------
Last Update Date | 12/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5224 CHENAULT RD
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27013-8862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-754-7026
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 BLYTHE BLVD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28203-5814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-355-7760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 17359
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------