Organization
BROOKLANE THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH G. CROCKETT OTR/L (OCCUPATIONAL THERAPIST)
(706) 379-4068
Entity
Organization
Contact information
Practice address
6724 MORGAN CT, YOUNG HARRIS, GA 30582-2551
(706) 379-4068
(706) 379-0640
Mailing address
6724 MORGAN CT, YOUNG HARRIS, GA 30582-2551
(706) 379-4068
(706) 379-0640
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
225XP0200
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7212219
—
NC
05
—
7301999
—
NC
Enumeration date
06/02/2008
Last updated
06/02/2008
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