Healthcare Provider Details

I. General information

NPI: 1265680482
Provider Name (Legal Business Name): STACIA L SCHRAMM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 SIMCA LN
CINCINNATI OH
45211-2400
US

IV. Provider business mailing address

4414 SIMCA LN
CINCINNATI OH
45211-2400
US

V. Phone/Fax

Practice location:
  • Phone: 513-598-6091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-01324
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: