Provider Demographics
NPI:1780046235
Name:KELSIE DEERING
Entity Type:Organization
Organization Name:KELSIE DEERING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEERING
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:319-540-2860
Mailing Address - Street 1:1417 FAN RD
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-7729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1417 FAN RD
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-7729
Practice Address - Country:US
Practice Address - Phone:319-540-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080450283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital