Provider Demographics
NPI:1144766056
Name:UMBERGER, VANESSA (MOT)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:UMBERGER
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 5TH ST # 57701
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7317
Mailing Address - Country:US
Mailing Address - Phone:605-755-4589
Mailing Address - Fax:
Practice Address - Street 1:2908 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7317
Practice Address - Country:US
Practice Address - Phone:605-755-4589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1014225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist