Provider Demographics
NPI:1730501537
Name:THE CENTER FOR LYMPHATIC THERAPY
Entity Type:Organization
Organization Name:THE CENTER FOR LYMPHATIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L,LLCC
Authorized Official - Phone:319-855-8098
Mailing Address - Street 1:2949 SIERRA CT SW STE 1
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-8503
Mailing Address - Country:US
Mailing Address - Phone:319-337-8865
Mailing Address - Fax:319-383-0002
Practice Address - Street 1:2949 SIERRA CT SW STE 1
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-8503
Practice Address - Country:US
Practice Address - Phone:319-337-8865
Practice Address - Fax:319-383-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002028225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB2857OtherPTAN
IA1235401647OtherINDIVIDUAL NPI