Provider Demographics
NPI:1053837286
Name:MOELLER, BROOKE RENEE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:RENEE
Last Name:MOELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 CEDAR SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:NEW LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52765-9309
Mailing Address - Country:US
Mailing Address - Phone:563-370-3026
Mailing Address - Fax:
Practice Address - Street 1:16620 40TH AVE N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-2687
Practice Address - Country:US
Practice Address - Phone:563-370-3026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist