MEDICARE: HALLI BROOK CULBREATH COTA/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	224Z00000X	Occupational Therapy Assistant	2307	OK
2	224Z00000X	Occupational Therapy Assistant	216706	TX

General Provider Information

NPI Number	:	1386224277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALLI BROOK CULBREATH COTA/L

Provider Business Mailing Address
First Line	:	2001 N LOY LAKE RD STE J
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-2837
Country	:	US
Telephone Number	:	903-487-5520
Fax Number	:	903-496-0004

Provider Business Practice Location Address
First Line	:	1309 E WADE WATTS AVE
Second Line	:
City	:	MCALESTER
State	:	OK
Zip	:	74501-5658
Country	:	US
Telephone Number	:	918-423-2220
Fax Number	:

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

Provider Enumeration Date	:	04/13/2021
Last Update Date	:	04/24/2026

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