Provider Demographics
NPI:1659442713
Name:OCCUPATIONAL THERAPY SERVICES OF NEBRASKA
Entity Type:Organization
Organization Name:OCCUPATIONAL THERAPY SERVICES OF NEBRASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT
Authorized Official - Prefix:
Authorized Official - First Name:ROGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-893-3331
Mailing Address - Street 1:21280 POLE LINE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NE
Mailing Address - Zip Code:68870-7025
Mailing Address - Country:US
Mailing Address - Phone:308-893-3331
Mailing Address - Fax:
Practice Address - Street 1:21280 POLE LINE RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NE
Practice Address - Zip Code:68870-7025
Practice Address - Country:US
Practice Address - Phone:308-893-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE246 & 248225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========OtherTAX ID.