Provider Demographics
NPI:1386854859
Name:ECHTERLING, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ECHTERLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22263 S. AVENUE
Mailing Address - Street 2:
Mailing Address - City:DALLAS CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50063-8069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22263 S. AVENUE
Practice Address - Street 2:
Practice Address - City:DALLAS CENTER
Practice Address - State:IA
Practice Address - Zip Code:50063
Practice Address - Country:US
Practice Address - Phone:515-360-1138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00624225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist