Provider Demographics
NPI:1891187506
Name:SCHOMER, ELLEN CLAIRE (LMT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:CLAIRE
Last Name:SCHOMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1625
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-1625
Mailing Address - Country:US
Mailing Address - Phone:808-937-1748
Mailing Address - Fax:
Practice Address - Street 1:71 BANYAN DR
Practice Address - Street 2:SUITE 115
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4693
Practice Address - Country:US
Practice Address - Phone:808-969-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13598225700000X
RI1458225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist