Provider Demographics
NPI:1316186489
Name:HUMMEL, BRIAN ANDREW (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ANDREW
Last Name:HUMMEL
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E TRINITY AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1946
Mailing Address - Country:US
Mailing Address - Phone:336-575-8772
Mailing Address - Fax:
Practice Address - Street 1:305 E TRINITY AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701
Practice Address - Country:US
Practice Address - Phone:336-575-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7103225X00000X
VA0119005177225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist