Provider Demographics
NPI:1396920088
Name:SCHOUTEN, JUDITH N (MED, OTR)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:N
Last Name:SCHOUTEN
Suffix:
Gender:F
Credentials:MED, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609A HICKORY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-2888
Mailing Address - Country:US
Mailing Address - Phone:262-534-2934
Mailing Address - Fax:
Practice Address - Street 1:609A HICKORY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-2888
Practice Address - Country:US
Practice Address - Phone:262-534-2934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-01
Last Update Date:2008-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI697026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist