Provider Demographics
NPI:1477314557
Name:VERTIGANS, JUSTICE (COTA)
Entity Type:Individual
Prefix:
First Name:JUSTICE
Middle Name:
Last Name:VERTIGANS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 N 118TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3643
Mailing Address - Country:US
Mailing Address - Phone:402-819-0045
Mailing Address - Fax:
Practice Address - Street 1:2335 E SAUNDERS ST
Practice Address - Street 2:PLAZA # 3
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-717-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218074224Z00000X
MA4610224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant