Healthcare Provider Details

I. General information

NPI: 1700780574
Provider Name (Legal Business Name): ELLIE SCHUMACHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 S PARK ST
NORTHWOOD ND
58267
US

IV. Provider business mailing address

4 S PARK ST
NORTHWOOD ND
58267
US

V. Phone/Fax

Practice location:
  • Phone: 701-587-6469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2307
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: