Provider Demographics
NPI:1366508566
Name:SCHNELLBAECHER, JO ANN (OTRL, MSOT)
Entity Type:Individual
Prefix:
First Name:JO ANN
Middle Name:
Last Name:SCHNELLBAECHER
Suffix:
Gender:F
Credentials:OTRL, MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 MONTAGNE CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1283
Mailing Address - Country:US
Mailing Address - Phone:907-276-7529
Mailing Address - Fax:907-694-8133
Practice Address - Street 1:3931 WINCHESTER LOOP
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3991
Practice Address - Country:US
Practice Address - Phone:907-276-7529
Practice Address - Fax:907-694-8133
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK948225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT5333Medicaid
AK151271Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID