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General NPI Number Information
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NPI Number | 1407697972
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Entity Type | Organization
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Legal Business Name | ORIGIN TRAUMA AND ADDICTION TREATMENT PLLC
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 958 COLLETT AVE STE 322
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City | BOWLING GREEN
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State | KY
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Zip | 42101-2309
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Country | US
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Telephone | 615-745-9058
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Fax |
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Provider Business Mailing Address
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Address Line | 2413 NASHVILLE RD STE 310
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City | BOWLING GREEN
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State | KY
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Zip | 42101-4101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTIAN CORD SCHRADER
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Credential | M.D.
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Telephone | 214-679-7017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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