Provider Demographics
NPI:1841740263
Name:SCHRODT, DEREK
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:SCHRODT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 HARVESTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520
Mailing Address - Country:US
Mailing Address - Phone:309-338-3306
Mailing Address - Fax:
Practice Address - Street 1:237 HARVESTER ROAD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2018
Practice Address - Country:US
Practice Address - Phone:309-338-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer