Individual
WILLIAM TYLER BROOME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
101 BRIGHTWATER DR, MYRTLE BEACH, SC 29579-8275
(843) 903-8300
Mailing address
101 BRIGHTWATER DR, MYRTLE BEACH, SC 29579-8275
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4794
SC
Other
Enumeration date
03/08/2018
Last updated
03/08/2018
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