Provider Demographics
NPI:1548690548
Name:SCHALSKI, JEREMY
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:SCHALSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8323 WILSON CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINBURG
Mailing Address - State:AR
Mailing Address - Zip Code:72946-3667
Mailing Address - Country:US
Mailing Address - Phone:479-965-6220
Mailing Address - Fax:
Practice Address - Street 1:48 W COLT SQUARE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2813
Practice Address - Country:US
Practice Address - Phone:479-582-2740
Practice Address - Fax:479-582-2746
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARO-T1376224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant