Individual
NICK SENGSOUKANE BACCAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 RIVERVIEW ST, DES MOINES, IA 50316-2343
(515) 226-1106
Mailing address
336 FLEETWOOD DR, DES MOINES, IA 50315-2835
(319) 361-6039
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
083495
IA
Other
Enumeration date
01/06/2017
Last updated
02/23/2017
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