Provider Demographics
NPI:1730465295
Name:OKOLOTOWICZ, CLARE (OTD)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:OKOLOTOWICZ
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:CLARE
Other - Middle Name:
Other - Last Name:VOIGTLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:1540 N 72ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-1924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1540 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-1924
Practice Address - Country:US
Practice Address - Phone:402-398-3958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1547225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070762201Medicaid
NE47070762200Medicaid