Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 00558 | IA |
N | 225XH1200X | Occupational Therapist - Hand | 9911000064 | CA |
NPI | 1104105303 |
---|---|
Provider Name | Brenda K. Pedersen |
First Address | Des Moines, IA 50309-1414 |
Second Address | Des Moines, IA 50309-1414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2011 |
Last Update Date | 05/08/2011 |