Provider Demographics
NPI:1811007552
Name:MAILANDER, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MAILANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5790 N 33RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-4651
Mailing Address - Country:US
Mailing Address - Phone:402-436-2992
Mailing Address - Fax:402-436-2996
Practice Address - Street 1:6900 A ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4120
Practice Address - Country:US
Practice Address - Phone:402-436-2535
Practice Address - Fax:402-436-2541
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1319OtherLICENSE
NE39777OtherBCBS
VA0119004048OtherLICENSE #
NE098787004Medicare UPIN