Provider Demographics
NPI:1083134910
Name:SCHNEIDER, MARILYN ANN (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ANN
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5018
Mailing Address - Country:US
Mailing Address - Phone:443-783-1598
Mailing Address - Fax:
Practice Address - Street 1:540 S ARAPEEN DR STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1216
Practice Address - Country:US
Practice Address - Phone:801-585-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10393680-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist