Provider Demographics
NPI:1073723045
Name:ROOSE, BECKY (OT)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:ROOSE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:VANSOELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2921 88TH CT
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4209
Mailing Address - Country:US
Mailing Address - Phone:515-276-0199
Mailing Address - Fax:
Practice Address - Street 1:516 3RD ST STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1771
Practice Address - Country:US
Practice Address - Phone:515-309-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00980225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00980OtherLICENSE NUMBER