Provider Demographics
NPI:1992939698
Name:VAN SCHYNDEL, JESSICA JO (OTR)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JO
Last Name:VAN SCHYNDEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:JO
Other - Last Name:BUTTERIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:900 MATTHEW LN
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-3889
Mailing Address - Country:US
Mailing Address - Phone:920-470-5353
Mailing Address - Fax:
Practice Address - Street 1:900 MATTHEW LN
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-3889
Practice Address - Country:US
Practice Address - Phone:920-470-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4677-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992939698Medicaid