Healthcare Provider Details

I. General information

NPI: 1386034353
Provider Name (Legal Business Name): DIANA SCHULZE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 RIVERSIDE DR
PAINESVILLE OH
44077-5323
US

IV. Provider business mailing address

382 BLACKBROOK RD
PAINESVILLE OH
44077-1294
US

V. Phone/Fax

Practice location:
  • Phone: 440-352-0668
  • Fax:
Mailing address:
  • Phone: 440-487-2071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.00987
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: