Provider Demographics
NPI:1659662302
Name:SCHAEFER, ELLEN CAROL (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:CAROL
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:ELLEN
Other - Middle Name:CAROL
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:22401 FOSTER WINTER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3724
Mailing Address - Country:US
Mailing Address - Phone:248-423-5100
Mailing Address - Fax:248-423-5194
Practice Address - Street 1:22401 FOSTER WINTER DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3724
Practice Address - Country:US
Practice Address - Phone:248-423-5100
Practice Address - Fax:248-423-5194
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001382225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation