Provider Demographics
NPI:1366964132
Name:SCHOOLEY, JOHN GARRET
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GARRET
Last Name:SCHOOLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:EMBUDO
Mailing Address - State:NM
Mailing Address - Zip Code:87531-0273
Mailing Address - Country:US
Mailing Address - Phone:505-385-7866
Mailing Address - Fax:
Practice Address - Street 1:733 CAMINO SANTA ANA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3683
Practice Address - Country:US
Practice Address - Phone:505-385-7866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NMOT4615225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician