Healthcare Provider Details

I. General information

NPI: 1124702386
Provider Name (Legal Business Name): SHOSHANA SCHMIDT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S MADISON AVE
SPRING VALLEY NY
10977-5474
US

IV. Provider business mailing address

492 WINDSOR RD
BERGENFIELD NJ
07621-4131
US

V. Phone/Fax

Practice location:
  • Phone: 551-486-4187
  • Fax:
Mailing address:
  • Phone: 551-486-4187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number007378-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: