Provider Demographics
NPI:1740724715
Name:SCHLAUCH, MICHAEL RYAN (COTA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RYAN
Last Name:SCHLAUCH
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 W MILLSTREAM RD
Mailing Address - Street 2:
Mailing Address - City:CREAM RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08514-2315
Mailing Address - Country:US
Mailing Address - Phone:609-752-5530
Mailing Address - Fax:
Practice Address - Street 1:1 APPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3985
Practice Address - Country:US
Practice Address - Phone:732-303-7416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-11
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09131400224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant