Healthcare Provider Details

I. General information

NPI: 1801055272
Provider Name (Legal Business Name): KENNETH DAVID SCHAPPE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 STATE ROUTE 299 SUITE #2
HIGHLAND NY
12528
US

IV. Provider business mailing address

PO BOX 236
BLOOMINGTON NY
12411-0236
US

V. Phone/Fax

Practice location:
  • Phone: 845-691-3500
  • Fax: 845-691-3500
Mailing address:
  • Phone: 845-691-3500
  • Fax: 845-691-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3622
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: