Healthcare Provider Details

I. General information

NPI: 1508334855
Provider Name (Legal Business Name): STEPHEN SCHUTZLER CTRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 SW 152ND ST
BURIEN WA
98166-1845
US

IV. Provider business mailing address

4610 SW COMUS PL
PORTLAND OR
97219-7273
US

V. Phone/Fax

Practice location:
  • Phone: 206-248-8226
  • Fax:
Mailing address:
  • Phone: 720-681-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number475909
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: