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Individual

NANETTE YVONNE ICEBERG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
405 RIO VISTA LN, RISING SUN, IN 47040-9497
(812) 438-2219
Mailing address
13418 ABERDEEN RD, DILLSBORO, IN 47018-5115
(812) 667-6318

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001804A
IN

Other

Enumeration date
06/02/2010
Last updated
06/02/2010
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