Provider Demographics
NPI:1194186874
Name:OBERLANDER, TYLER JOHN (MS ATC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JOHN
Last Name:OBERLANDER
Suffix:
Gender:M
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:NE
Mailing Address - Zip Code:69143-0282
Mailing Address - Country:US
Mailing Address - Phone:605-685-8103
Mailing Address - Fax:
Practice Address - Street 1:1115 S COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6108
Practice Address - Country:US
Practice Address - Phone:308-696-7456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer