Provider Demographics
NPI:1275779068
Name:SCHROEDER, CHARITY LYN (OTR/L)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:LYN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55974-1418
Mailing Address - Country:US
Mailing Address - Phone:319-360-3107
Mailing Address - Fax:507-322-1856
Practice Address - Street 1:172 W MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:MN
Practice Address - Zip Code:55974-1444
Practice Address - Country:US
Practice Address - Phone:319-360-3107
Practice Address - Fax:507-322-1856
Is Sole Proprietor?:No
Enumeration Date:2008-12-28
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106103225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist