Provider Demographics
NPI:1821109471
Name:RUPPERT, TARA N (OTRL, CHT)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:N
Last Name:RUPPERT
Suffix:
Gender:F
Credentials:OTRL, CHT
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:N
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7728 S 71ST ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3045
Mailing Address - Country:US
Mailing Address - Phone:402-596-0516
Mailing Address - Fax:
Practice Address - Street 1:1702 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3652
Practice Address - Country:US
Practice Address - Phone:402-682-4210
Practice Address - Fax:402-682-4256
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE842225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P65880Medicare UPIN
NE275851Medicare ID - Type Unspecified