Provider Demographics
NPI:1629549860
Name:MINCHOW, MARCIE A (OT)
Entity Type:Individual
Prefix:MISS
First Name:MARCIE
Middle Name:A
Last Name:MINCHOW
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:A
Other - Last Name:MINCHOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:404 W F ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5231
Mailing Address - Country:US
Mailing Address - Phone:308-660-7867
Mailing Address - Fax:
Practice Address - Street 1:1002 E PHILIP AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6104
Practice Address - Country:US
Practice Address - Phone:308-532-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1803225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist