Provider Demographics
NPI:1609640838
Name:ROMAN, LILIANA (OTD OTR/L)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:ROMAN
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 1:6455 GALLERIA DR APT 4111
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6699
Mailing Address - Country:US
Mailing Address - Phone:402-942-4479
Mailing Address - Fax:
Practice Address - Street 1:4825 EP TRUE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-6403
Practice Address - Country:US
Practice Address - Phone:515-207-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist