Provider Demographics
NPI:1700904224
Name:SCHMIDT, VALERIE ANNE (OTR)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANNE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 HEATHER CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4744
Mailing Address - Country:US
Mailing Address - Phone:815-482-4504
Mailing Address - Fax:262-248-2309
Practice Address - Street 1:780 HEATHER CIR
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4744
Practice Address - Country:US
Practice Address - Phone:815-482-4504
Practice Address - Fax:262-248-2309
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-004879225XP0200X
WI2647-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700904224Medicaid