MEDICARE: WESLEY ADONIS CASTRO OTD, OTR/L, CLT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	101922	IA

General Provider Information

NPI Number	:	1356926281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WESLEY ADONIS CASTRO OTD, OTR/L, CLT

Provider Business Mailing Address
First Line	:	3011 19TH AVE N
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-7872
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 6TH AVE N
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-3541
Country	:	US
Telephone Number	:	515-576-1138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	03/11/2021

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