Healthcare Provider Details

I. General information

NPI: 1245162502
Provider Name (Legal Business Name): SALLY M SCHUMACK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 W 106TH ST
BLOOMINGTON MN
55431-4126
US

IV. Provider business mailing address

15867 CINNAMON WAY
ROSEMOUNT MN
55068-3800
US

V. Phone/Fax

Practice location:
  • Phone: 952-484-0144
  • Fax:
Mailing address:
  • Phone: 952-484-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: