Provider Demographics
NPI:1033394218
Name:SCHAFER, MICHELLE LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19904 E 1900TH AVE
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:IL
Mailing Address - Zip Code:62481-2256
Mailing Address - Country:US
Mailing Address - Phone:618-562-3960
Mailing Address - Fax:
Practice Address - Street 1:19904 E 1900TH AVE
Practice Address - Street 2:
Practice Address - City:YALE
Practice Address - State:IL
Practice Address - Zip Code:62481-2256
Practice Address - Country:US
Practice Address - Phone:618-562-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant