Provider Demographics
NPI:1407062201
Name:SCHWAB, SUSAN CAROL (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CAROL
Last Name:SCHWAB
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HAMILTON CT
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-2061
Mailing Address - Country:US
Mailing Address - Phone:715-344-5848
Mailing Address - Fax:
Practice Address - Street 1:1800 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-7215
Practice Address - Country:US
Practice Address - Phone:715-344-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI118-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV40549800Medicaid