Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 00599 | IA |
NPI | 1316299019 |
---|---|
Provider Name | Mrs. Lavon Rosendahl |
First Address | Des Moines, IA 50315-4342 |
Second Address | Des Moines, IA 50316-2343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2012 |
Last Update Date | 05/10/2012 |