Provider Demographics
NPI:1497362016
Name:RASTENBURG, PAIGE RENEE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:RENEE
Last Name:RASTENBURG
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 CARSS ST
Mailing Address - Street 2:
Mailing Address - City:LEIGHTON
Mailing Address - State:IA
Mailing Address - Zip Code:50143-7707
Mailing Address - Country:US
Mailing Address - Phone:708-843-2084
Mailing Address - Fax:
Practice Address - Street 1:1229 C AVE E
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-4246
Practice Address - Country:US
Practice Address - Phone:641-672-3306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA116601225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist