Provider Demographics
NPI:1881054187
Name:SCHNEIDER, LAURA (OT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 N CLARK ST
Mailing Address - Street 2:#267
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2290
Mailing Address - Country:US
Mailing Address - Phone:708-359-4355
Mailing Address - Fax:
Practice Address - Street 1:5315 N CLARK ST
Practice Address - Street 2:#267
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2290
Practice Address - Country:US
Practice Address - Phone:708-359-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007997225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist