Provider Demographics
NPI:1215580048
Name:LINCOLN LYMPHEDEMA AND OCCUPATIONAL THERAPY, LLC
Entity Type:Organization
Organization Name:LINCOLN LYMPHEDEMA AND OCCUPATIONAL THERAPY, LLC
Other - Org Name:THE LYMPHEDEMA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L, CLT
Authorized Official - Phone:402-840-5457
Mailing Address - Street 1:3940 CORNHUSKER HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1509
Mailing Address - Country:US
Mailing Address - Phone:402-840-5457
Mailing Address - Fax:
Practice Address - Street 1:3940 CORNHUSKER HWY STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-1509
Practice Address - Country:US
Practice Address - Phone:402-840-5457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-21
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty