Provider Demographics
NPI:1164712477
Name:SCHULMAN, SALLY ANN
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:SCHULMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 856
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-0856
Mailing Address - Country:US
Mailing Address - Phone:847-903-5604
Mailing Address - Fax:224-788-5112
Practice Address - Street 1:317 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2735
Practice Address - Country:US
Practice Address - Phone:248-336-2868
Practice Address - Fax:248-336-2879
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011049191041C0700X
MI5201002884225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical