Provider Demographics
NPI:1063937969
Name:PRILLAMAN, BROOKE JOYCE (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:JOYCE
Last Name:PRILLAMAN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:NICOLE
Other - Last Name:JOYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:110 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:VA
Mailing Address - Zip Code:24055-6010
Mailing Address - Country:US
Mailing Address - Phone:276-734-0205
Mailing Address - Fax:
Practice Address - Street 1:812 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3109
Practice Address - Country:US
Practice Address - Phone:276-638-4890
Practice Address - Fax:276-638-5139
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119-007432225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119-007432OtherVIRGINIA BOARD OF MEDICINE STATE LICENSE NUMBER