MEDICARE: LORIANN E BROCK OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	R2512	KY

General Provider Information

NPI Number	:	1215271747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIANN E BROCK OTR/L

Provider Business Mailing Address
First Line	:	4310 LAHNNA DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-3971
Country	:	US
Telephone Number	:	502-438-6306
Fax Number	:

Provider Business Practice Location Address
First Line	:	4310 LAHNNA DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-3971
Country	:	US
Telephone Number	:	502-438-6306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2012
Last Update Date	:	11/21/2012

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