Provider Demographics
NPI:1134492507
Name:WILLIAMS, BROOKE MICHELE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MICHELE
Last Name:WILLIAMS
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 1:101 MARTOWICZ COURT
Mailing Address - Street 2:PO BOX 575
Mailing Address - City:MILL RIFT
Mailing Address - State:PA
Mailing Address - Zip Code:18340-0575
Mailing Address - Country:US
Mailing Address - Phone:570-491-4591
Mailing Address - Fax:
Practice Address - Street 1:101 E STATE ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-3109
Practice Address - Country:US
Practice Address - Phone:855-492-8878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008018-1224Z00000X
NJ46TA09095800224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant