Provider Demographics
NPI:1619140266
Name:HADLAND, CAROLINE JOY (OTD OTR L)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:JOY
Last Name:HADLAND
Suffix:
Gender:F
Credentials:OTD OTR L
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:JOY
Other - Last Name:LUBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD OTR L
Mailing Address - Street 1:5401 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2150
Mailing Address - Country:US
Mailing Address - Phone:402-483-9626
Mailing Address - Fax:402-486-9098
Practice Address - Street 1:5401 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2150
Practice Address - Country:US
Practice Address - Phone:402-483-9626
Practice Address - Fax:402-486-9098
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1335225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47043959902Medicaid