Individual
COURTNEY L BROOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
15476B DEDEAUX RD, GULFPORT, MS 39503-2637
(228) 539-3232
(228) 539-3230
Mailing address
PO BOX 8419, BILOXI, MS 39535-8087
(228) 388-5714
(228) 388-0017
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2180
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090-15385
—
MS
01
—
1033218524
GROUP NPI
MS
01
—
256545
MEDICARE PART A
MS
01
—
C02726
MEDICARE GROUP
MS
Enumeration date
05/29/2008
Last updated
05/29/2008
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