=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770345472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTORIA ANN DIETRICK OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2024
-----------------------------------------------------
Last Update Date | 02/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1314 7TH ST UNIT A
-----------------------------------------------------
City | JESUP
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50648-1187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-827-3440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1314 7TH ST UNIT A
-----------------------------------------------------
City | JESUP
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50648-1187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-827-3440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 124577
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------