Provider Demographics
NPI:1275967523
Name:SCHROEDER, LISA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3776
Mailing Address - Country:US
Mailing Address - Phone:734-981-3709
Mailing Address - Fax:734-981-5384
Practice Address - Street 1:5900 N LILLEY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3776
Practice Address - Country:US
Practice Address - Phone:734-981-3709
Practice Address - Fax:734-981-5384
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008504225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist