Provider Demographics
NPI:1194159244
Name:SCHMITZ OCCUPATIONAL THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:SCHMITZ OCCUPATIONAL THERAPY SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:360-402-9269
Mailing Address - Street 1:8881 WINDHAM CT NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-3884
Mailing Address - Country:US
Mailing Address - Phone:360-539-8801
Mailing Address - Fax:360-539-1745
Practice Address - Street 1:677 WOODLAND SQUARE LOOP SE
Practice Address - Street 2:SUITE D-8
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1000
Practice Address - Country:US
Practice Address - Phone:360-539-8801
Practice Address - Fax:360-539-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00004494225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2030740Medicaid