Provider Demographics
NPI:1891710208
Name:SCHROEDER, JENNIFER LANE (OTR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LANE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 PINE TREE RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-1625
Mailing Address - Country:US
Mailing Address - Phone:903-753-8499
Mailing Address - Fax:903-753-8502
Practice Address - Street 1:822 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5433
Practice Address - Country:US
Practice Address - Phone:903-753-8499
Practice Address - Fax:903-753-8502
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110330225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist