Provider Demographics
NPI:1891705273
Name:RYSTROM, CONNIE (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:RYSTROM
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 HALL RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411-7910
Mailing Address - Country:US
Mailing Address - Phone:319-366-1886
Mailing Address - Fax:319-366-1611
Practice Address - Street 1:2750 1ST AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4831
Practice Address - Country:US
Practice Address - Phone:319-366-1886
Practice Address - Fax:319-366-1611
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00152225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand