Provider Demographics
NPI:1164898771
Name:SCHNEIDER, STEPHANIE LUECKE (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LUECKE
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 VALLEY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-2128
Mailing Address - Country:US
Mailing Address - Phone:660-395-5029
Mailing Address - Fax:
Practice Address - Street 1:1111 VALLEY VIEW CT
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2128
Practice Address - Country:US
Practice Address - Phone:660-395-5029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100253452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer