Provider Demographics
NPI:1528575693
Name:SCHMIDT, KATIE SHILOY
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:SHILOY
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4956 QUEEN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1909
Mailing Address - Country:US
Mailing Address - Phone:952-923-9087
Mailing Address - Fax:
Practice Address - Street 1:4956 QUEEN AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1909
Practice Address - Country:US
Practice Address - Phone:952-923-9087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR103707225X00000X
OR266073225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN$$$$$$$$$OtherOT
MN$$$$$$$$$OtherOT