Provider Demographics
NPI:1982038030
Name:SCHOFIELD, JENNIE SUSANNA
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:SUSANNA
Last Name:SCHOFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4025
Mailing Address - Country:US
Mailing Address - Phone:617-697-3937
Mailing Address - Fax:
Practice Address - Street 1:74 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1147
Practice Address - Country:US
Practice Address - Phone:617-696-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA900000859225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist