MEDICARE: KIM SCHNEIDER 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	338062-4201	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881795797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM SCHNEIDER OTRL

Provider Business Mailing Address
First Line	:	PO BOX 3497
Second Line	:
City	:	STURTEVANT
State	:	WI
Zip	:	53177-0300
Country	:	US
Telephone Number	:	877-552-2996
Fax Number	:	866-245-8064

Provider Business Practice Location Address
First Line	:	5991 S 3500 W
Second Line	:	SUITE 300
City	:	ROY
State	:	UT
Zip	:	84067-6701
Country	:	US
Telephone Number	:	801-985-2700
Fax Number	:	801-985-2707

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	04/01/2014

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Directions to “ KIM SCHNEIDER OTRL” Practice Location

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