Provider Demographics
NPI:1417167107
Name:SCHNIDT, CELIA B (COTA)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:B
Last Name:SCHNIDT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 E 3950 N
Mailing Address - Street 2:
Mailing Address - City:FILER
Mailing Address - State:ID
Mailing Address - Zip Code:83328-5218
Mailing Address - Country:US
Mailing Address - Phone:208-539-5852
Mailing Address - Fax:
Practice Address - Street 1:1828 BRIDGEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3051
Practice Address - Country:US
Practice Address - Phone:208-736-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTA091224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant