Provider Demographics
NPI:1235502667
Name:SCHROEDER, DEVIN (LAT, ATC, OTC)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:LAT, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 STULTS RD STE 210
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-1291
Mailing Address - Country:US
Mailing Address - Phone:260-355-3110
Mailing Address - Fax:
Practice Address - Street 1:2003 STULTS RD STE 210
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1291
Practice Address - Country:US
Practice Address - Phone:260-355-3110
Practice Address - Fax:260-355-3114
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001874A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer