Provider Demographics
NPI:1689947194
Name:SCHWARTZ, TANYA SUE (COTA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:SUE
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10925 WITMER RD
Mailing Address - Street 2:
Mailing Address - City:GRABILL
Mailing Address - State:IN
Mailing Address - Zip Code:46741-9707
Mailing Address - Country:US
Mailing Address - Phone:260-704-6174
Mailing Address - Fax:
Practice Address - Street 1:10925 WITMER RD
Practice Address - Street 2:
Practice Address - City:GRABILL
Practice Address - State:IN
Practice Address - Zip Code:46741-9707
Practice Address - Country:US
Practice Address - Phone:260-704-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002033A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant