Provider Demographics
NPI:1720389463
Name:SCHUMM, KEENAN RUSSELL (COTA)
Entity Type:Individual
Prefix:
First Name:KEENAN
Middle Name:RUSSELL
Last Name:SCHUMM
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13016 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:LEO
Mailing Address - State:IN
Mailing Address - Zip Code:46765-9639
Mailing Address - Country:US
Mailing Address - Phone:260-804-2161
Mailing Address - Fax:
Practice Address - Street 1:3611 N WARE RD.
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-688-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210627224Z00000X
IN32001772A224Z00000X
WAOC60138335224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant