MEDICARE: THE CENTER FOR LYMPHATIC THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	002028	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IB2857	OTHER	IA	PTAN
2	1235401647	OTHER	IA	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1730501537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CENTER FOR LYMPHATIC THERAPY

Provider Business Mailing Address
First Line	:	2949 SIERRA CT SW STE 1
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-8503
Country	:	US
Telephone Number	:	319-337-8865
Fax Number	:	319-383-0002

Provider Business Practice Location Address
First Line	:	2949 SIERRA CT SW STE 1
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-8503
Country	:	US
Telephone Number	:	319-337-8865
Fax Number	:	319-383-0002

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MS. MELISSA ACOSTA
Credential	:	M.S., OTR/L,LLCC
Telephone Number	:	319-855-8098

Provider Enumeration Date	:	01/13/2014
Last Update Date	:	01/13/2014

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Directions to “THE CENTER FOR LYMPHATIC THERAPY ” Practice Location

Language	Start Address	Practice Location

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