Provider Demographics
NPI:1942451679
Name:LANG, ANDREA KAYE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KAYE
Last Name:LANG
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:KAYE
Other - Last Name:RUNZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-7050
Mailing Address - Fax:515-643-7051
Practice Address - Street 1:25 W HICKMAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-5018
Practice Address - Country:US
Practice Address - Phone:515-643-7050
Practice Address - Fax:515-643-7051
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01788225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist