MEDICARE: MR. DAVID DANIEL SCHROEDER OTRL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	102130	FM

General Provider Information

NPI Number	:	1275747602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID DANIEL SCHROEDER OTRL

Provider Business Mailing Address
First Line	:	29774 RIVERVIEW RD
Second Line	:
City	:	FERGUS FALLS
State	:	MN
Zip	:	56537-7937
Country	:	US
Telephone Number	:	218-770-6781
Fax Number	:

Provider Business Practice Location Address
First Line	:	29774 RIVERVIEW RD
Second Line	:
City	:	FERGUS FALLS
State	:	MN
Zip	:	56537-7937
Country	:	US
Telephone Number	:	218-770-6781
Fax Number	:	218-736-4392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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