Provider Demographics
NPI:1699245381
Name:VISSER, DANA ELAINE
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:ELAINE
Last Name:VISSER
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 1:1101 9TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-2501
Mailing Address - Country:US
Mailing Address - Phone:712-722-8125
Mailing Address - Fax:
Practice Address - Street 1:807 MAIN STREE SUITE C
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:IA
Practice Address - Zip Code:51239-7204
Practice Address - Country:US
Practice Address - Phone:712-439-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090450225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist