MEDICARE: MRS. BROOKE GUMM NOGUEIRA 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	0119005683	VA

General Provider Information

NPI Number	:	1790126712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BROOKE GUMM NOGUEIRA OTR/L

Provider Business Mailing Address
First Line	:	1610 VALLEY RIDGE RD
Second Line	:
City	:	COVINGTON
State	:	VA
Zip	:	24426-6343
Country	:	US
Telephone Number	:	540-969-6597
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 W MAIN ST
Second Line	:
City	:	COVINGTON
State	:	VA
Zip	:	24426-1517
Country	:	US
Telephone Number	:	540-962-6226
Fax Number	:

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

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	07/08/2013

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