Provider Demographics
NPI:1639321417
Name:PROBASCO, HEATHER LYNN (MOTR/L)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:PROBASCO
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NE
Mailing Address - Zip Code:68361-1515
Mailing Address - Country:US
Mailing Address - Phone:402-366-0081
Mailing Address - Fax:
Practice Address - Street 1:1325 H ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NE
Practice Address - Zip Code:68361-2124
Practice Address - Country:US
Practice Address - Phone:402-759-3167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1305225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist