Provider Demographics
NPI:1598218091
Name:SCHAEFER, ELLEN ANNE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ANNE
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 HANSON AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3166
Mailing Address - Country:US
Mailing Address - Phone:973-876-2799
Mailing Address - Fax:
Practice Address - Street 1:31 STAFFORD AVE
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7246
Practice Address - Country:US
Practice Address - Phone:540-658-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007037174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist