Basic Information
| Provider Information | |||||||||
| NPI: | 1982883310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRAIT | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | HIAWATHA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522331626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3197433583 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3661 ROCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522459271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193517460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2007 | ||||||||
| LastUpdateDate: | 11/01/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 00297 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.