Provider Demographics
NPI:1750643755
Name:PIDGEON, JANICE S (COTA/L)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:S
Last Name:PIDGEON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:JANN
Other - Middle Name:
Other - Last Name:PIDGEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:905 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1744
Mailing Address - Country:US
Mailing Address - Phone:319-339-4535
Mailing Address - Fax:
Practice Address - Street 1:811 3RD ST
Practice Address - Street 2:
Practice Address - City:KALONA
Practice Address - State:IA
Practice Address - Zip Code:52247-9493
Practice Address - Country:US
Practice Address - Phone:319-656-2421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00582224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant