Healthcare Provider Details

I. General information

NPI: 1528505815
Provider Name (Legal Business Name): ALEX GELEYNSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 3RD ST NE
SIOUX CENTER IA
51250-1716
US

IV. Provider business mailing address

338 3RD ST NE
SIOUX CENTER IA
51250-1716
US

V. Phone/Fax

Practice location:
  • Phone: 920-583-5846
  • Fax:
Mailing address:
  • Phone: 920-583-5846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number353262
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: