Provider Demographics
NPI:1861927501
Name:SCHOMAKER, OLIVIA ANN
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ANN
Last Name:SCHOMAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7866 TEABERRY DR
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-8422
Mailing Address - Country:US
Mailing Address - Phone:989-254-9965
Mailing Address - Fax:
Practice Address - Street 1:7866 TEABERRY DR
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-8422
Practice Address - Country:US
Practice Address - Phone:989-254-9965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI526660067336106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician