Provider Demographics
NPI:1154592376
Name:SCHAECHER, KEN M (PT)
Entity type:Individual
Prefix:DR
First Name:KEN
Middle Name:M
Last Name:SCHAECHER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4301
Mailing Address - Country:US
Mailing Address - Phone:405-743-0101
Mailing Address - Fax:405-743-1116
Practice Address - Street 1:904 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4301
Practice Address - Country:US
Practice Address - Phone:405-743-0101
Practice Address - Fax:405-743-1116
Is Sole Proprietor?:No
Enumeration Date:2008-03-15
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1154592376Medicare PIN