Provider Demographics
NPI:1992745178
Name:RUSTAN, JANAN MARIE (OT)
Entity type:Individual
Prefix:MRS
First Name:JANAN
Middle Name:MARIE
Last Name:RUSTAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:JANAN
Other - Middle Name:MARIE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1454 30TH STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1312
Mailing Address - Country:US
Mailing Address - Phone:515-223-6620
Mailing Address - Fax:515-223-9625
Practice Address - Street 1:1454 30TH STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1312
Practice Address - Country:US
Practice Address - Phone:515-223-6620
Practice Address - Fax:515-223-9625
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00554225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist