=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396695565
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON RAE SCHNEIDER II
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2026
-----------------------------------------------------
Last Update Date | 01/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 CURVE CREST BLVD W
-----------------------------------------------------
City | STILLWATER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55082-6040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-439-1234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13455 FONDANT TRL N
-----------------------------------------------------
City | HUGO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55038-5432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-246-6473
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0019X
-----------------------------------------------------
Taxonomy Name | Physical Rehabilitation Occupational Therapist
-----------------------------------------------------
License Number | 103598
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------