Provider Demographics
NPI:1649243098
Name:RUGGEBERG, JAMES MATTHEW (OTR/L)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MATTHEW
Last Name:RUGGEBERG
Suffix:
Gender:M
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 1:2358 270TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND MOUND
Mailing Address - State:IA
Mailing Address - Zip Code:52751-9673
Mailing Address - Country:US
Mailing Address - Phone:563-847-1230
Mailing Address - Fax:563-322-2107
Practice Address - Street 1:1800 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802-1812
Practice Address - Country:US
Practice Address - Phone:563-327-0133
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00728225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist