=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730355942
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL ANN SCHMITT DICKERT MS OTR L LPTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2008
-----------------------------------------------------
Last Update Date | 05/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 E MORGAN AVE
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53207-3771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-977-5005
-----------------------------------------------------
Fax | 414-977-5011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18940 CAVENDISH RD
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53045-8159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-783-6620
-----------------------------------------------------
Fax | 262-783-1513
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 1185-019
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 852-026
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------