=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750812756
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN SCHINDLER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2017
-----------------------------------------------------
Last Update Date | 03/22/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 181 JERSEY AVE
-----------------------------------------------------
City | PORT JERVIS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12771-2609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-863-9662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 502 HULSETOWN RD
-----------------------------------------------------
City | CAMPBELL HALL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10916-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 000376
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------