Provider Demographics
NPI:1821361544
Name:SCHULTZ, SUSAN MICHELLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MICHELLE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 OLENE AVE N
Mailing Address - Street 2:
Mailing Address - City:WEST LAKELAND
Mailing Address - State:MN
Mailing Address - Zip Code:55082-1835
Mailing Address - Country:US
Mailing Address - Phone:651-387-1257
Mailing Address - Fax:
Practice Address - Street 1:1551 OLENE AVE N
Practice Address - Street 2:
Practice Address - City:WEST LAKELAND
Practice Address - State:MN
Practice Address - Zip Code:55082-1835
Practice Address - Country:US
Practice Address - Phone:651-387-1257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102094225X00000X
WI3251026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist