Provider Demographics
NPI:1457530396
Name:SCHNEIDER, ANGELA MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13813 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IL
Mailing Address - Zip Code:62692-8203
Mailing Address - Country:US
Mailing Address - Phone:217-435-2024
Mailing Address - Fax:
Practice Address - Street 1:2800 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1016
Practice Address - Country:US
Practice Address - Phone:217-787-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant