Individual
CORLEY BROOKS LYLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
605 JOHNSTON RD, NINETY SIX, SC 29666-1417
(864) 543-3100
Mailing address
133 DEVORE RD, GREENWOOD, SC 29649-9555
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5411
SC
Other
Enumeration date
08/16/2022
Last updated
08/16/2022
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