Provider Demographics
NPI:1902110430
Name:SCHMIDT, MARIEL (OT)
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4171 LAS PALMAS SQ
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-6627
Mailing Address - Country:US
Mailing Address - Phone:858-646-7709
Mailing Address - Fax:
Practice Address - Street 1:4171 LAS PALMAS SQ
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-6627
Practice Address - Country:US
Practice Address - Phone:858-646-7709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11208225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist