MEDICARE: GRACE ELIZABETH SCHUMACHER RD

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	225XP0200X	Pediatric Occupational Therapist	247100	AK
2	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist	247100	AK
3	133V00000X	Registered Dietitian	105564	AK
4	225XM0800X	Mental Health Occupational Therapist	247100	AK

General Provider Information

NPI Number	:	1700395787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE ELIZABETH SCHUMACHER RD

Provider Business Mailing Address
First Line	:	1150 S. COLONY WAY
Second Line	:	STE 3, PMB 269
City	:	PALMER
State	:	AK
Zip	:	99645-6972
Country	:	US
Telephone Number	:	907-631-9005
Fax Number	:

Provider Business Practice Location Address
First Line	:	10355 E PALMER WASILLA HWY # 120-A
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-8876
Country	:	US
Telephone Number	:	469-275-4507
Fax Number	:	469-278-6762

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

Provider Enumeration Date	:	09/22/2017
Last Update Date	:	03/12/2026

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