Healthcare Provider Details

I. General information

NPI: 1184865578
Provider Name (Legal Business Name): JOANNA RACHEAL SCHROEDER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOSIE SCHROEDER

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PROFESSIONAL CT
LAFAYETTE IN
47905-5152
US

IV. Provider business mailing address

402 SINCLAIR DR
WEST LAFAYETTE IN
47906-8691
US

V. Phone/Fax

Practice location:
  • Phone: 765-448-1758
  • Fax:
Mailing address:
  • Phone: 765-838-0389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31004715A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: