Provider Demographics
NPI:1477270353
Name:SCHROEDER, KATHY (OTL)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1580 COLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-9706
Mailing Address - Country:US
Mailing Address - Phone:614-670-6407
Mailing Address - Fax:
Practice Address - Street 1:9180 ANTARES AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-2333
Practice Address - Country:US
Practice Address - Phone:833-231-2589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-4070225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist