Provider Demographics
NPI:1215451877
Name:VAN PEURSEM, KATLIN JO (OT)
Entity type:Individual
Prefix:
First Name:KATLIN
Middle Name:JO
Last Name:VAN PEURSEM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KATLIN
Other - Middle Name:JO
Other - Last Name:WIERTSEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 N. 7TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-1235
Mailing Address - Country:US
Mailing Address - Phone:712-324-6169
Mailing Address - Fax:712-324-6170
Practice Address - Street 1:800 OAK STREET
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1235
Practice Address - Country:US
Practice Address - Phone:712-324-6151
Practice Address - Fax:712-324-6170
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087403225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist