Provider Demographics
NPI:1275370629
Name:MUNSTERMAN, KAITLYN JO
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:JO
Last Name:MUNSTERMAN
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 1:2016 53RD ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-1540
Mailing Address - Country:US
Mailing Address - Phone:515-689-8421
Mailing Address - Fax:
Practice Address - Street 1:715 SW ANKENY RD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-5999
Practice Address - Country:US
Practice Address - Phone:515-289-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA127789OtherIOWA OCCUPATIONAL THERAPY LICENSE