Organization
SPROUT PEDIATRIC THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH ANN VAN BRUGGEN MS IN OT (OWNER)
(712) 441-1710
Entity
Organization
Contact information
Practice address
3498 450TH ST, ORANGE CITY, IA 51041-7506
(712) 737-9065
(712) 737-9064
Mailing address
4244 CHESTNUT AVE, HAWARDEN, IA 51023-7406
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
001958
IA
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0170200
—
IA
Enumeration date
07/11/2016
Last updated
06/05/2017
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