MEDICARE: SUSAN CATHERINE MOYLE-SCHROEDER PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	7232A	AZ

General Provider Information

NPI Number	:	1053534792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN CATHERINE MOYLE-SCHROEDER PTA

Provider Business Mailing Address
First Line	:	171 WHISPERING PINE WAY
Second Line	:
City	:	HOLLISTER
State	:	MO
Zip	:	65672-5574
Country	:	US
Telephone Number	:	417-230-6144
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 1ST ST N STE 200
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6939
Country	:	US
Telephone Number	:	888-909-5038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	12/21/2018

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Directions to “ SUSAN CATHERINE MOYLE-SCHROEDER PTA” Practice Location

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