Provider Demographics
NPI:1619146438
Name:LOY, MARILYN KATHLEEN (OT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:KATHLEEN
Last Name:LOY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:KATHLEEN
Other - Last Name:VOGELSBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5 FRIAR TUCK CIR
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-1880
Mailing Address - Country:US
Mailing Address - Phone:712-362-3758
Mailing Address - Fax:
Practice Address - Street 1:111 SALE BARN RD
Practice Address - Street 2:STE 3
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-7341
Practice Address - Country:US
Practice Address - Phone:712-213-1500
Practice Address - Fax:712-213-1502
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00648225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist