Provider Demographics
NPI:1568855831
Name:VAN BRUGGEN, ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VAN BRUGGEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4244 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:HAWARDEN
Mailing Address - State:IA
Mailing Address - Zip Code:51023-7406
Mailing Address - Country:US
Mailing Address - Phone:712-441-1710
Mailing Address - Fax:
Practice Address - Street 1:3498 450TH ST
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-7506
Practice Address - Country:US
Practice Address - Phone:712-737-9065
Practice Address - Fax:712-737-9064
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001958225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist