Provider Demographics
NPI:1609947761
Name:GOEDERT, JILL (OT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:GOEDERT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:211 W 33RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-3485
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 W 33RD ST STE A
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3485
Practice Address - Country:US
Practice Address - Phone:308-236-5884
Practice Address - Fax:308-236-9621
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE246225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081973500Medicaid
NE47081973500Medicaid