Provider Demographics
NPI:1023510864
Name:SCHMALZER, ELLYN (OTR/L)
Entity type:Individual
Prefix:MS
First Name:ELLYN
Middle Name:
Last Name:SCHMALZER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 STEBBINS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-1330
Mailing Address - Country:US
Mailing Address - Phone:774-209-0068
Mailing Address - Fax:
Practice Address - Street 1:2 COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-1321
Practice Address - Country:US
Practice Address - Phone:978-568-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11905225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist