Provider Demographics
NPI:1730455676
Name:SHRADER, COLETTE JEANANN (MS)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:JEANANN
Last Name:SHRADER
Suffix:
Gender:F
Credentials:MS
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:628 S PRESA ST # 5
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-1054
Mailing Address - Country:US
Mailing Address - Phone:210-802-8313
Mailing Address - Fax:
Practice Address - Street 1:628 S PRESA ST # 5
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-1054
Practice Address - Country:US
Practice Address - Phone:210-802-8313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologist