Provider Demographics
NPI:1457340663
Name:SCHILLING, JIM F (MS, LAT)
Entity type:Individual
Prefix:MR
First Name:JIM
Middle Name:F
Last Name:SCHILLING
Suffix:
Gender:M
Credentials:MS, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 N MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4038
Mailing Address - Country:US
Mailing Address - Phone:414-967-0025
Mailing Address - Fax:
Practice Address - Street 1:2545 N MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4066
Practice Address - Country:US
Practice Address - Phone:414-967-0025
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI374 - 0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer