Provider Demographics
NPI:1710749890
Name:SCHMUCK, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SCHMUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26995 GLENSIDE LN
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-3173
Mailing Address - Country:US
Mailing Address - Phone:216-272-4983
Mailing Address - Fax:
Practice Address - Street 1:26995 GLENSIDE LN
Practice Address - Street 2:
Practice Address - City:OLMSTED TWP
Practice Address - State:OH
Practice Address - Zip Code:44138-3173
Practice Address - Country:US
Practice Address - Phone:216-272-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRCP7417227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered