Provider Demographics
NPI:1629112008
Name:SCHROEDER, THERESA M (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 E COE DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4647
Mailing Address - Country:US
Mailing Address - Phone:405-733-4014
Mailing Address - Fax:405-733-4014
Practice Address - Street 1:1401 S DOUGLAS BLVD
Practice Address - Street 2:SUITE W
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5266
Practice Address - Country:US
Practice Address - Phone:405-733-4014
Practice Address - Fax:405-733-4014
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK404156-00175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK404156-00OtherNATIONAL CERTIFICATION #