Provider Demographics
NPI:1639325228
Name:SCHMIDT, CYNTHIA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12273 MITCHELL LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:WI
Mailing Address - Zip Code:54411-9001
Mailing Address - Country:US
Mailing Address - Phone:715-581-5044
Mailing Address - Fax:
Practice Address - Street 1:12273 MITCHELL LN
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:WI
Practice Address - Zip Code:54411-9001
Practice Address - Country:US
Practice Address - Phone:715-581-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2315-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1639325228Medicaid