Provider Demographics
NPI:1023386034
Name:ETMUND, LANCE ELLIOT (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:ELLIOT
Last Name:ETMUND
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4985
Mailing Address - Country:US
Mailing Address - Phone:402-416-7339
Mailing Address - Fax:
Practice Address - Street 1:6101 NORMAL BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2767
Practice Address - Country:US
Practice Address - Phone:402-489-7175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1539225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist