Individual
JOHN BROOME II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
116 LANE DR, TRINITY, NC 27370-9343
(336) 431-8888
Mailing address
136 MACKWOOD RD, MOORESVILLE, NC 28115-7819
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
8726
NC
Other
Enumeration date
06/25/2013
Last updated
06/25/2013
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