Provider Demographics
NPI:1447405626
Name:SCHOMMER, ELLEN MARIE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MARIE
Last Name:SCHOMMER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:MARIE
Other - Last Name:SCHLUETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:6020 GANDER RD E
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4534
Mailing Address - Country:US
Mailing Address - Phone:937-233-1021
Mailing Address - Fax:
Practice Address - Street 1:565 PARK HILLS XING
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-7572
Practice Address - Country:US
Practice Address - Phone:937-879-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA 01207224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant