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General NPI Number Information
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NPI Number | 1700903788
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Entity Type | Individual
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Provider Name | NICOLE ELIZABETH LETENDRE OTR,L
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Gender | Female
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 06/12/2013
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Provider Practice Location Address
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Address Line | 5406 MERLE HAY ROAD
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City | JOHNSTON
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State | IA
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Zip | 50131
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Country | US
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Telephone | 612-747-8032
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 SW 35TH ST #1202
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City | ANKENY
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State | IA
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Zip | 50023-5904
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Country | US
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Telephone |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 103272
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License Number State | MN
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