Provider Demographics
NPI:1811005721
Name:BANGSUND, KATHERINE M (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:BANGSUND
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 S 57TH ST
Mailing Address - Street 2:STE D
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5217
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:5930 S 57TH ST
Practice Address - Street 2:STE D
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5217
Practice Address - Country:US
Practice Address - Phone:402-421-0896
Practice Address - Fax:402-421-0945
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE55225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist