Provider Demographics
NPI:1003084831
Name:DEMOSS, VICKI (MS,OTR/L, MPA)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:DEMOSS
Suffix:
Gender:F
Credentials:MS,OTR/L, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 SE 23RD ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-2629
Mailing Address - Country:US
Mailing Address - Phone:515-480-5695
Mailing Address - Fax:
Practice Address - Street 1:6500 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1603
Practice Address - Country:US
Practice Address - Phone:515-270-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00755225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist