Provider Demographics
NPI:1366847832
Name:DEJONGE, MINDY A (OT)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:A
Last Name:DEJONGE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 W 35TH ST
Mailing Address - Street 2:STE 2
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2909
Mailing Address - Country:US
Mailing Address - Phone:308-237-7388
Mailing Address - Fax:308-237-7394
Practice Address - Street 1:717 BROW AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:NE
Practice Address - Zip Code:68920
Practice Address - Country:US
Practice Address - Phone:308-928-3002
Practice Address - Fax:308-928-2774
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1542225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist