Provider Demographics
NPI:1366632598
Name:YAECK, BRIAN LORNE (OTRL)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LORNE
Last Name:YAECK
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 NEWMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5238
Mailing Address - Country:US
Mailing Address - Phone:252-634-2676
Mailing Address - Fax:252-633-2577
Practice Address - Street 1:738 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5238
Practice Address - Country:US
Practice Address - Phone:252-634-2676
Practice Address - Fax:252-633-2577
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4750225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist