Individual
MRS. HOLLY SUZANNE BRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.R., C.H.T.
Contact information
Practice address
1900 SAINT CHARLES ST, JASPER, IN 47546-9145
(812) 634-1211
Mailing address
908 CLAY ST, JASPER, IN 47546-2804
(812) 219-2967
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31001714A
IN
Other
Enumeration date
06/30/2010
Last updated
09/24/2010
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