Provider Demographics
NPI:1366881781
Name:SCHROEDER, INGRID ELLEN (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:ELLEN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:ELLEN
Other - Last Name:ARNESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1203 BARTLETT AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720
Mailing Address - Country:US
Mailing Address - Phone:608-213-2927
Mailing Address - Fax:
Practice Address - Street 1:1203 BARTLETT AVENUE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720
Practice Address - Country:US
Practice Address - Phone:608-213-2927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4899-27224Z00000X
AZ4613224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant