Individual
DIANE LYNN BACKOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10929 NE 75TH ST, BONDURANT, IA 50035-1146
(515) 779-8850
Mailing address
10929 NE 75TH ST, BONDURANT, IA 50035-1146
(515) 779-8850
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/04/2013
Last updated
12/04/2013
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