Provider Demographics
NPI:1841717204
Name:KOBBERDAHL, DIANNE HORAN (OTR/L , CHT)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:HORAN
Last Name:KOBBERDAHL
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 1:705 20TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-4824
Mailing Address - Country:US
Mailing Address - Phone:515-669-5065
Mailing Address - Fax:
Practice Address - Street 1:701 E 1ST ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2061
Practice Address - Country:US
Practice Address - Phone:515-965-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-27
Last Update Date:2017-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA507225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand