Provider Demographics
NPI:1366715922
Name:SIEVERS, PENNY SUSAN (OTR/L)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:SUSAN
Last Name:SIEVERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:SUSAN
Other - Last Name:FISCUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2660
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2660
Mailing Address - Country:US
Mailing Address - Phone:319-233-3044
Mailing Address - Fax:319-233-0722
Practice Address - Street 1:1810 4TH ST SW
Practice Address - Street 2:SUITE 103A
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-4389
Practice Address - Country:US
Practice Address - Phone:319-352-6400
Practice Address - Fax:319-352-4655
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01477225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist