Provider Demographics
NPI:1871862078
Name:SCHMIDT, DEEANN MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:DEEANN
Middle Name:MARIE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:DEEANN
Other - Middle Name:MARIE
Other - Last Name:EIRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:N7414 NIAGARA LN
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-8059
Mailing Address - Country:US
Mailing Address - Phone:192-092-3446
Mailing Address - Fax:
Practice Address - Street 1:2448 S 102ND ST STE 340
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-2147
Practice Address - Country:US
Practice Address - Phone:800-776-7016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1726-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant