Provider Demographics
NPI:1669979753
Name:SCHRODER, OLIVIA RAE (MS, AT, ATC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:RAE
Last Name:SCHRODER
Suffix:
Gender:F
Credentials:MS, AT, ATC
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:RAE
Other - Last Name:KOSNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:629 TAFFY LN
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-2959
Mailing Address - Country:US
Mailing Address - Phone:989-292-2651
Mailing Address - Fax:
Practice Address - Street 1:1500 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1849
Practice Address - Country:US
Practice Address - Phone:231-672-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-013342255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer