Healthcare Provider Details

I. General information

NPI: 1962659763
Provider Name (Legal Business Name): HEIDI MARIE SCHNEIDER-STINSON C.O.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HIGH ST
BOWLING GREEN KY
42101-1746
US

IV. Provider business mailing address

115 QUAIL RIDGE CIR APT B
GLASGOW KY
42141-5115
US

V. Phone/Fax

Practice location:
  • Phone: 270-893-3296
  • Fax:
Mailing address:
  • Phone: 812-204-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberA3753
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: