Provider Demographics
NPI:1215198916
Name:WERNIMONT-DIEHL, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:WERNIMONT-DIEHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LINCOLN CIR SE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1862
Mailing Address - Country:US
Mailing Address - Phone:712-737-5234
Mailing Address - Fax:
Practice Address - Street 1:1000 LINCOLN CIR SE
Practice Address - Street 2:SUITE 400
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1862
Practice Address - Country:US
Practice Address - Phone:712-737-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA995225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist