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Individual

TIM RAY BROCKETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
56 S MAIN ST, CROSSVILLE, TN 38555-4520
(440) 812-2853
(931) 707-9474
Mailing address
56 S MAIN ST, CROSSVILLE, TN 38555-4520
(440) 812-2853

Taxonomy

Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
224Z00000X
Occupational Therapy Assistant
OTA16207
FL
225X00000X
Occupational Therapist
OT22381
FL
225XP0200X
Pediatric Occupational Therapist
Primary
7758
TN

Other

Enumeration date
01/11/2018
Last updated
05/19/2025
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