Provider Demographics
NPI:1093759920
Name:STROESSER, MARY G (OT,CHT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:G
Last Name:STROESSER
Suffix:
Gender:F
Credentials:OT,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11704 W CENTER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4375
Mailing Address - Country:US
Mailing Address - Phone:402-691-0400
Mailing Address - Fax:402-691-1580
Practice Address - Street 1:11704 W CENTER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4375
Practice Address - Country:US
Practice Address - Phone:402-691-0400
Practice Address - Fax:402-691-1580
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1059225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470533491OtherFEIN
NE06547OtherBLUE CROSS BLUE SHIELD
NE10025222500Medicaid
NE10025222500Medicaid