Provider Demographics
NPI:1720599079
Name:SCHALEY, BROOKE MICHELLE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MICHELLE
Last Name:SCHALEY
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 1:3401 45TH ST S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8970
Mailing Address - Country:US
Mailing Address - Phone:701-356-4384
Mailing Address - Fax:
Practice Address - Street 1:3401 45TH ST S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8970
Practice Address - Country:US
Practice Address - Phone:701-356-4384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant