Healthcare Provider Details

I. General information

NPI: 1104077536
Provider Name (Legal Business Name): TERRI LYNNE SCHULDT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9157 TIMBERMILL CT
JACKSONVILLE FL
32256-6707
US

IV. Provider business mailing address

9157 TIMBERMILL CT
JACKSONVILLE FL
32256-6707
US

V. Phone/Fax

Practice location:
  • Phone: 904-654-5082
  • Fax:
Mailing address:
  • Phone: 904-654-5082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT13342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: