Provider Demographics
NPI:1730584418
Name:SCHMOLLY, BROOKE (CTRS)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:SCHMOLLY
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 ROHRMANN RD
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16115-2007
Mailing Address - Country:US
Mailing Address - Phone:724-714-3884
Mailing Address - Fax:
Practice Address - Street 1:619 S MARION AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA64246225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist