Provider Demographics
NPI:1689307332
Name:EDSTROM, LEXIE MARIE (OT)
Entity Type:Individual
Prefix:
First Name:LEXIE
Middle Name:MARIE
Last Name:EDSTROM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LEXIE
Other - Middle Name:MARIE
Other - Last Name:REMMENGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:NE
Mailing Address - Zip Code:68937-0404
Mailing Address - Country:US
Mailing Address - Phone:308-325-7957
Mailing Address - Fax:
Practice Address - Street 1:3601 CIMARRON PLZ STE 105
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2883
Practice Address - Country:US
Practice Address - Phone:402-463-2077
Practice Address - Fax:402-463-2062
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2667225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist