Healthcare Provider Details

I. General information

NPI: 1780890285
Provider Name (Legal Business Name): SCOTT WILFRED SCHMITZ OTRL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MOORE ST
CHARLESTON AR
72933-9115
US

IV. Provider business mailing address

501 MOORE ST
CHARLESTON AR
72933-9115
US

V. Phone/Fax

Practice location:
  • Phone: 479-965-0927
  • Fax:
Mailing address:
  • Phone: 479-965-0927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1176
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: