Provider Demographics
NPI:1629296413
Name:DEARDORFF, BRET (MS)
Entity Type:Individual
Prefix:MR
First Name:BRET
Middle Name:
Last Name:DEARDORFF
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 S 114TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 W PROSPECTOR PL
Practice Address - Street 2:BOX 94949
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1970
Practice Address - Country:US
Practice Address - Phone:402-479-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist