Provider Demographics
NPI:1659898229
Name:ZIMBELMAN, LAUREN ELIZ
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZ
Last Name:ZIMBELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 S C ST APT 601
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-2146
Mailing Address - Country:US
Mailing Address - Phone:308-383-1813
Mailing Address - Fax:
Practice Address - Street 1:BROOKESTONE VIEW
Practice Address - Street 2:850 LAUREL PARKWAY DRIVE
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822
Practice Address - Country:US
Practice Address - Phone:308-767-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1010224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant