Individual
CHARLOTTE BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2701 CHESTNUT STATION CT, LOUISVILLE, KY 40299-6395
(800) 335-1060
Mailing address
3953 WEBER WAY, LEXINGTON, KY 40514-1009
(859) 202-1316
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
170593
KY
Other
Enumeration date
03/28/2017
Last updated
03/28/2017
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