Provider Demographics
NPI:1013075142
Name:SCHMIDT, RAMONA DAWN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:RAMONA
Middle Name:DAWN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:RAMONA
Other - Middle Name:DAWN
Other - Last Name:PALECEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1040 PILGRIM WAY
Mailing Address - Street 2:WOODSIDE LUTHERAN HOME ATTEN: MONA SCHMIDT
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5028
Mailing Address - Country:US
Mailing Address - Phone:920-405-3522
Mailing Address - Fax:920-405-3522
Practice Address - Street 1:1040 PILGRIM WAY
Practice Address - Street 2:WOODSIDE LUTHERAN HOME
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5028
Practice Address - Country:US
Practice Address - Phone:920-405-3522
Practice Address - Fax:920-405-3522
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3553026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40700400Medicaid