Individual
HALEY ALANE DIETRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
217 E BREMER AVE, WAVERLY, IA 50677-3435
(319) 352-1234
Mailing address
10418 JUBILEE RD, LA PORTE CITY, IA 50651-2059
(319) 240-2868
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
099828
IA
Other
Enumeration date
11/04/2020
Last updated
11/04/2020
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