Provider Demographics
NPI:1730355942
Name:SCHMITT DICKERT, CAROL ANN (MS OTR L LPTA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:SCHMITT DICKERT
Suffix:
Gender:F
Credentials:MS OTR L LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18940 CAVENDISH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-8159
Mailing Address - Country:US
Mailing Address - Phone:262-783-6620
Mailing Address - Fax:262-783-1513
Practice Address - Street 1:2801 E MORGAN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-3771
Practice Address - Country:US
Practice Address - Phone:414-977-5005
Practice Address - Fax:414-977-5011
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1185-019225200000X
WI852-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40505600Medicaid