Provider Demographics
NPI:1427280270
Name:SCHNETTLER, JULIENNE (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIENNE
Middle Name:
Last Name:SCHNETTLER
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 1:1691 E US 23 STE 4
Mailing Address - Street 2:
Mailing Address - City:EAST TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730-9337
Mailing Address - Country:US
Mailing Address - Phone:989-479-7550
Mailing Address - Fax:
Practice Address - Street 1:1691 E US 23 STE 4
Practice Address - Street 2:
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730-9337
Practice Address - Country:US
Practice Address - Phone:989-479-7550
Practice Address - Fax:989-702-2260
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007519225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1508383837Medicaid