=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538835616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN CHRISTOPHER SCHIEDEL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2021
-----------------------------------------------------
Last Update Date | 08/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 PROGRESS PL
-----------------------------------------------------
City | RUCKERSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22968-3245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-939-9006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1140
-----------------------------------------------------
City | STANARDSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22973-1140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-939-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 0813001161
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------