Provider Demographics
NPI:1205134137
Name:SCHMITT, CYNTHIA M (MSED, OTR)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:SCHMITT
Suffix:
Gender:F
Credentials:MSED, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 W. LAWRENCE STREET
Mailing Address - Street 2:COMMUNITY CARE INC
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1574
Mailing Address - Country:US
Mailing Address - Phone:920-750-5525
Mailing Address - Fax:
Practice Address - Street 1:1506 S. ONEIDA ST
Practice Address - Street 2:ST. ELIZABETH HOSPITAL
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915
Practice Address - Country:US
Practice Address - Phone:920-738-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI313225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI313-27OtherWI LICENSE
AA386201OtherNBCOT