Healthcare Provider Details

I. General information

NPI: 1073348330
Provider Name (Legal Business Name): NATALIA KIRBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 LAFAYETTE AVE
STORY CITY IA
50248-1454
US

IV. Provider business mailing address

107 NE 44TH ST APT 201
ANKENY IA
50021-4955
US

V. Phone/Fax

Practice location:
  • Phone: 515-733-4325
  • Fax:
Mailing address:
  • Phone: 563-505-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number128354
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: