Provider Demographics
NPI:1508334855
Name:SCHUTZLER, STEPHEN (CTRS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SCHUTZLER
Suffix:
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 SW COMUS PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7273
Mailing Address - Country:US
Mailing Address - Phone:720-681-2006
Mailing Address - Fax:
Practice Address - Street 1:1033 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1845
Practice Address - Country:US
Practice Address - Phone:206-248-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL475909225800000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist