Provider Demographics
NPI:1558701557
Name:KOUBA, BECKY (COAT/L)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:KOUBA
Suffix:
Gender:F
Credentials:COAT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12568 S 82ND ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4417
Mailing Address - Country:US
Mailing Address - Phone:402-350-0101
Mailing Address - Fax:
Practice Address - Street 1:12568 S 82ND ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4417
Practice Address - Country:US
Practice Address - Phone:402-350-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE721224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant