Provider Demographics
NPI:1720387467
Name:SCHULENBERG, MIRANDA S (OTR)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:S
Last Name:SCHULENBERG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:SHIPPY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1011 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4226
Mailing Address - Country:US
Mailing Address - Phone:920-459-4339
Mailing Address - Fax:
Practice Address - Street 1:1011 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4226
Practice Address - Country:US
Practice Address - Phone:920-459-4339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5002225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics