Provider Demographics
NPI:1366994964
Name:SCHULZE, VICTORIA BLAZE (OTR/L)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:BLAZE
Last Name:SCHULZE
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 1:182 N COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-2310
Mailing Address - Country:US
Mailing Address - Phone:480-686-4340
Mailing Address - Fax:
Practice Address - Street 1:182 N COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-2310
Practice Address - Country:US
Practice Address - Phone:480-686-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-29
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009532-1224Z00000X
NY027309225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant