Provider Demographics
NPI:1326234485
Name:SCHNEIDER, MARITA L (AP, DOM)
Entity Type:Individual
Prefix:MS
First Name:MARITA
Middle Name:L
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 MAIN ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-4084
Mailing Address - Country:US
Mailing Address - Phone:772-480-6127
Mailing Address - Fax:
Practice Address - Street 1:1069 MAIN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-4084
Practice Address - Country:US
Practice Address - Phone:772-480-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2333171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist