Provider Demographics
NPI:1699597633
Name:FLATTERY, ANNELISE GABRIELLE KLENK (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:ANNELISE
Middle Name:GABRIELLE KLENK
Last Name:FLATTERY
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:ANNELISE
Other - Middle Name:GABRIELLE
Other - Last Name:KLENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:1306 HIGHWAY 57 STE B
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50665-1075
Mailing Address - Country:US
Mailing Address - Phone:319-346-9783
Mailing Address - Fax:319-346-9785
Practice Address - Street 1:121 TOWER ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:IA
Practice Address - Zip Code:50622-2201
Practice Address - Country:US
Practice Address - Phone:319-406-0185
Practice Address - Fax:319-406-0187
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA127827225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist