Provider Demographics
NPI:1548621949
Name:TOLLE, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:TOLLE
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 1:819 COUNTRY LANE RD
Mailing Address - Street 2:
Mailing Address - City:KEOSAUQUA
Mailing Address - State:IA
Mailing Address - Zip Code:52565-1001
Mailing Address - Country:US
Mailing Address - Phone:319-293-3761
Mailing Address - Fax:319-293-6379
Practice Address - Street 1:102A EAST SOUTH ST.
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:IA
Practice Address - Zip Code:52585
Practice Address - Country:US
Practice Address - Phone:641-777-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081463224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant