Healthcare Provider Details

I. General information

NPI: 1184993545
Provider Name (Legal Business Name): JENNIFER L KLUEVER MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 CORAL CT SUITE 1
CORALVILLE IA
52241-2837
US

IV. Provider business mailing address

865 LINCOLN RD SUITE L10
BETTENDORF IA
52722-4190
US

V. Phone/Fax

Practice location:
  • Phone: 319-853-0596
  • Fax: 319-853-0983
Mailing address:
  • Phone: 563-355-9200
  • Fax: 563-355-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number002172
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: