Individual
KELLY DIRKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1130 W 53RD ST, DAVENPORT, IA 52806-2401
(563) 391-5342
Mailing address
1130 W 53RD ST, DAVENPORT, IA 52806-2401
(563) 391-5342
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
01768
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01768
STATE OF IOWA LICENSE OCCUPATIONAL THERAPY
IA
Enumeration date
03/23/2016
Last updated
03/23/2016
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