Provider Demographics
NPI:1578036729
Name:KALOUS, KARISSA (OTR/L)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:KALOUS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 HILLSBORO DR SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-4940
Mailing Address - Country:US
Mailing Address - Phone:319-551-3875
Mailing Address - Fax:
Practice Address - Street 1:301 5TH ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:IA
Practice Address - Zip Code:50643-7776
Practice Address - Country:US
Practice Address - Phone:319-988-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093627225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist