Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 086094 | IA |
N | 225XG0600X | Occupational Therapist - Gerontology | 086094 | IA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 086094 | IA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 086094 | IA |
NPI | 1821687989 |
---|---|
Provider Name | Edward Diemer |
First Address | Waukee, IA 50263-8233 |
Second Address | Des Moines, IA 50309-1406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2021 |
Last Update Date | 13/01/2021 |