Provider Demographics
NPI:1770557191
Name:SCHMIDT SOLBERG, KRISTIN MICHELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:SCHMIDT SOLBERG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 210TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:IA
Mailing Address - Zip Code:52236-8524
Mailing Address - Country:US
Mailing Address - Phone:319-662-4153
Mailing Address - Fax:
Practice Address - Street 1:3207 220TH TRL
Practice Address - Street 2:
Practice Address - City:AMANA
Practice Address - State:IA
Practice Address - Zip Code:52203-8206
Practice Address - Country:US
Practice Address - Phone:319-622-3131
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01382225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23172OtherWELLMARK PROVIDER ID