Healthcare Provider Details

I. General information

NPI: 1699294256
Provider Name (Legal Business Name): KALEY SCHROEDER AT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 OAK VALLEY DR
ANN ARBOR MI
48103-8901
US

IV. Provider business mailing address

686 SOUTH ST
GRASS LAKE MI
49240-9767
US

V. Phone/Fax

Practice location:
  • Phone: 734-998-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601001464
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: