Provider Demographics
NPI:1134300502
Name:SCHRODER, SCHELLI HOEFINGHOFF
Entity Type:Individual
Prefix:
First Name:SCHELLI
Middle Name:HOEFINGHOFF
Last Name:SCHRODER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SCHELLI
Other - Middle Name:HOEFINGHOFF
Other - Last Name:SCHRODER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3876 TURKEYFOOT ROAD
Mailing Address - Street 2:
Mailing Address - City:ELSMERE
Mailing Address - State:KY
Mailing Address - Zip Code:41018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3876 TURKEYFOOT RD
Practice Address - Street 2:
Practice Address - City:ELSMERE
Practice Address - State:KY
Practice Address - Zip Code:41018-2838
Practice Address - Country:US
Practice Address - Phone:859-342-8775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R1314172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker