Provider Demographics
NPI:1215043575
Name:BROCKINGTON, CHARLES ARTHUR (OTR)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ARTHUR
Last Name:BROCKINGTON
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:ARTHUR
Other - Last Name:BROCKINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1729 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4356
Mailing Address - Country:US
Mailing Address - Phone:956-532-8871
Mailing Address - Fax:956-973-8972
Practice Address - Street 1:4412 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2480
Practice Address - Country:US
Practice Address - Phone:956-973-8972
Practice Address - Fax:956-973-8972
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111342225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist