Provider Demographics
NPI:1972810364
Name:SCHMIDT, COLLEEN M (OTR/L)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:MCFARLANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:440 VILLAGE GREEN CT SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4166
Mailing Address - Country:US
Mailing Address - Phone:770-638-8027
Mailing Address - Fax:
Practice Address - Street 1:440 VILLAGE GREEN CT SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-4166
Practice Address - Country:US
Practice Address - Phone:770-638-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT001700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist