Healthcare Provider Details

I. General information

NPI: 1922571454
Provider Name (Legal Business Name): TYLER OMMEN OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W LINCOLN WAY
JEFFERSON IA
50129-1645
US

IV. Provider business mailing address

PO BOX 461
NEVADA IA
50201-0461
US

V. Phone/Fax

Practice location:
  • Phone: 515-386-0248
  • Fax: 515-386-2480
Mailing address:
  • Phone: 515-382-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number087034
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: