Healthcare Provider Details

I. General information

NPI: 1982519054
Provider Name (Legal Business Name): SAMUEL ROBERT HOMAN OTR/L, OTD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 BERKSHIRE PKWY
CLIVE IA
50325-2801
US

IV. Provider business mailing address

2830 100TH ST STE 100
URBANDALE IA
50322-3874
US

V. Phone/Fax

Practice location:
  • Phone: 515-644-8740
  • Fax:
Mailing address:
  • Phone: 515-225-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number140512
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: