Provider Demographics
NPI:1376966994
Name:MAPLE VALLEY - ANTHON OTO
Entity Type:Organization
Organization Name:MAPLE VALLEY - ANTHON OTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHONA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINGENSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-373-5246
Mailing Address - Street 1:501 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:IA
Mailing Address - Zip Code:51034-1138
Mailing Address - Country:US
Mailing Address - Phone:712-881-1315
Mailing Address - Fax:
Practice Address - Street 1:110 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:ANTHON
Practice Address - State:IA
Practice Address - Zip Code:51004-8192
Practice Address - Country:US
Practice Address - Phone:712-881-1315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)