Provider Demographics
NPI:1457833634
Name:CORLEY, BROOKE TAYLOR (OTR)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:TAYLOR
Last Name:CORLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1905 LEARY LANE
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901
Mailing Address - Country:US
Mailing Address - Phone:361-573-0731
Mailing Address - Fax:361-573-1594
Practice Address - Street 1:1905 LEARY LANE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-573-0731
Practice Address - Fax:361-573-1594
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119361225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist