Basic Information
| Provider Information | |||||||||
| NPI: | 1053534792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOYLE-SCHROEDER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | CATHERINE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 171 WHISPERING PINE WAY | ||||||||
| Address2: | |||||||||
| City: | HOLLISTER | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656725574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172306144 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 333 1ST ST N STE 200 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322506939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889095038 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 12/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 7232A | AZ | Y | Other Service Providers | Specialist |
No ID Information.