Provider Demographics
NPI:1336418383
Name:SCHROEDER, JENA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 W FRYE RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6112
Mailing Address - Country:US
Mailing Address - Phone:480-812-7096
Mailing Address - Fax:480-812-9643
Practice Address - Street 1:1350 N PENNINGTON DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-8571
Practice Address - Country:US
Practice Address - Phone:480-812-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4769225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist