Provider Demographics
NPI:1437630209
Name:MAYOU, REBECCA JO (OTD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JO
Last Name:MAYOU
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:TERRIL
Mailing Address - State:IA
Mailing Address - Zip Code:51364-0294
Mailing Address - Country:US
Mailing Address - Phone:712-348-1488
Mailing Address - Fax:
Practice Address - Street 1:6750 WESTOWN PKWY STE 110
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7716
Practice Address - Country:US
Practice Address - Phone:515-225-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087709225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist