Healthcare Provider Details

I. General information

NPI: 1831230358
Provider Name (Legal Business Name): DEBRA DAMICO SCHMITZ OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 N GORDON PL
MILWAUKEE WI
53212
US

IV. Provider business mailing address

2555 N GORDON PL
MILWAUKEE WI
53212-3018
US

V. Phone/Fax

Practice location:
  • Phone: 414-378-5303
  • Fax: 414-376-5552
Mailing address:
  • Phone: 414-378-5303
  • Fax: 414-376-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6197-26
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056006553
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: