Provider Demographics
NPI:1407027220
Name:SCHRUM, EDWINNA MICHELLE
Entity Type:Individual
Prefix:
First Name:EDWINNA
Middle Name:MICHELLE
Last Name:SCHRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:E.
Other - Middle Name:MICHELLE
Other - Last Name:SCHRUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8423 N 54TH LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-6103
Mailing Address - Country:US
Mailing Address - Phone:602-670-2302
Mailing Address - Fax:
Practice Address - Street 1:8423 N 54TH LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-6103
Practice Address - Country:US
Practice Address - Phone:602-670-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4110225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist