Healthcare Provider Details

I. General information

NPI: 1841717204
Provider Name (Legal Business Name): DIANNE HORAN KOBBERDAHL OTR/L , CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2017
Last Update Date: 08/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 1ST ST
ANKENY IA
50021-2061
US

IV. Provider business mailing address

705 20TH ST
WEST DES MOINES IA
50265-4824
US

V. Phone/Fax

Practice location:
  • Phone: 515-965-5311
  • Fax:
Mailing address:
  • Phone: 515-669-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number507
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: