Provider Demographics
NPI:1912629395
Name:DESCHEPPER, LYDIA CHRISTINE
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:CHRISTINE
Last Name:DESCHEPPER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LYDIA
Other - Middle Name:CHRISTINE
Other - Last Name:KAHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11623 ARBOR STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144
Mailing Address - Country:US
Mailing Address - Phone:402-334-6063
Mailing Address - Fax:402-334-6063
Practice Address - Street 1:2001 WESTOWN PKWY STE 104
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-1540
Practice Address - Country:US
Practice Address - Phone:515-223-6620
Practice Address - Fax:402-334-6063
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2689225X00000X
IA115587225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0134760Medicaid