Provider Demographics
NPI:1891315628
Name:PETTINGER, JODIE M (OTR/L, CLC)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:M
Last Name:PETTINGER
Suffix:
Gender:F
Credentials:OTR/L, CLC
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:M
Other - Last Name:JASPERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:7 HILLCREST HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-9611
Mailing Address - Country:US
Mailing Address - Phone:319-329-9051
Mailing Address - Fax:
Practice Address - Street 1:7 HILLCREST HEIGHTS LN
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-9611
Practice Address - Country:US
Practice Address - Phone:319-329-9051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00686225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist