Provider Demographics
NPI:1346512514
Name:HULL, BROOKE R (OTA/L)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:R
Last Name:HULL
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28610-8223
Mailing Address - Country:US
Mailing Address - Phone:828-310-0665
Mailing Address - Fax:
Practice Address - Street 1:333 EAST LEE ST
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8132
Practice Address - Country:US
Practice Address - Phone:336-679-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3848224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant