Provider Demographics
NPI:1164490736
Name:SCHLEMER, GERALD L (MED,ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:L
Last Name:SCHLEMER
Suffix:
Gender:M
Credentials:MED,ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 NOTRE DAME AVE
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2627
Mailing Address - Country:US
Mailing Address - Phone:618-656-4434
Mailing Address - Fax:
Practice Address - Street 1:SOUTHERN ILLINOIS UNIVERSITY EDWARDSVILLE
Practice Address - Street 2:CAMPUS BOX 1129 ATHLETICS
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62026-0001
Practice Address - Country:US
Practice Address - Phone:618-650-2883
Practice Address - Fax:618-650-3369
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer