Provider Demographics
NPI:1316299019
Name:ROSENDAHL, LAVON (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LAVON
Middle Name:
Last Name:ROSENDAHL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E HEROLD AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-4342
Mailing Address - Country:US
Mailing Address - Phone:515-282-9119
Mailing Address - Fax:515-282-9119
Practice Address - Street 1:701 RIVERVIEW ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2343
Practice Address - Country:US
Practice Address - Phone:515-266-1106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00599225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology