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General NPI Number Information
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NPI Number | 1083542393
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Entity Type | Individual
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Provider Name | STEPHANIE ROSE LURSEN COTA/L, CPST
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Gender | Female
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Dates
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Enumeration Date | 05/08/2026
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Last Update Date | 05/08/2026
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Provider Practice Location Address
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Address Line | 8230 HICKMAN RD
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City | CLIVE
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State | IA
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Zip | 50325-4305
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Country | US
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Telephone | 515-207-9712
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Fax |
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Provider Business Mailing Address
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Address Line | 3320 PERIDOT AVE APT 220
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City | AMES
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State | IA
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Zip | 50010-1208
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Country | US
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Telephone | 641-330-3920
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 115594
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License Number State | IA
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