Healthcare Provider Details

I. General information

NPI: 1386240729
Provider Name (Legal Business Name): CHELSEA RENEE SCHANING COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/10/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9509 RT-100
NEW HAVEN MO
63068
US

IV. Provider business mailing address

1780 PRICE RD
OWENSVILLE MO
65066-2701
US

V. Phone/Fax

Practice location:
  • Phone: 573-237-2103
  • Fax:
Mailing address:
  • Phone: 537-301-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.005493
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2020018063
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: