Provider Demographics
NPI:1437215522
Name:SCHULZE, AGNES WINIFRED (OTR)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:WINIFRED
Last Name:SCHULZE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:AGNES.
Other - Middle Name:WINIFRED
Other - Last Name:SCHULZE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:41 WESTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1547
Mailing Address - Country:US
Mailing Address - Phone:631-662-6799
Mailing Address - Fax:631-421-4540
Practice Address - Street 1:214 WALL ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-7804
Practice Address - Country:US
Practice Address - Phone:631-662-6799
Practice Address - Fax:631-421-4540
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002581-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY463843POtherHIP/EMBLEM
NY4599867OtherAETNA
NYQ74171OtherEMPIRE BLUE CROSS BLUE SHIELD
NY463843POtherHIP/EMBLEM