Provider Demographics
NPI:1295754117
Name:SCHMITZ, THERESA ANN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8881 WINDHAM CT NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-3884
Mailing Address - Country:US
Mailing Address - Phone:360-402-9269
Mailing Address - Fax:360-539-1745
Practice Address - Street 1:677 WOODLAND SQUARE LOOP SE
Practice Address - Street 2:SUITE D-8
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1000
Practice Address - Country:US
Practice Address - Phone:360-539-8801
Practice Address - Fax:360-539-1745
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00004494225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA203074000Medicaid