Healthcare Provider Details

I. General information

NPI: 1235326547
Provider Name (Legal Business Name): DOUGLAS RUSSEL SCHOCH LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N WALNUT ST
WILLOW SPRINGS MO
65793-1436
US

IV. Provider business mailing address

206 N WALNUT ST
WILLOW SPRINGS MO
65793-1436
US

V. Phone/Fax

Practice location:
  • Phone: 417-469-0293
  • Fax:
Mailing address:
  • Phone: 417-469-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2006022684
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4311
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: