Provider Demographics
NPI:1417439175
Name:SHAEFER, BROOKE BIDDLE (OTR/L)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:BIDDLE
Last Name:SHAEFER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ASHLEY
Other - Last Name:BIDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:109 PUTNEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CAVY
Mailing Address - State:NC
Mailing Address - Zip Code:27518
Mailing Address - Country:US
Mailing Address - Phone:919-673-3747
Mailing Address - Fax:
Practice Address - Street 1:4030 CARDINAL @ N HILLS STREET
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-2616
Practice Address - Country:US
Practice Address - Phone:919-673-3847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11583225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist