Individual
MRS. CONSTANCE MARIE BRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS OTRL
Contact information
Practice address
5415 W FRIENDLY AVE STE A, GREENSBORO, NC 27410-4255
(336) 772-5499
(336) 292-6064
Mailing address
130 PARK BOULEVARD, WINSTON SALEM, NC 27127-2042
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4237
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13740
BLUE CROSS AND BLUE SHIEL
NC
05
—
7301713
—
NC
Enumeration date
01/03/2007
Last updated
07/07/2011
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