Provider Demographics
NPI:1942556998
Name:MAZUMDAR, SUSHMIT (MBA,OTR/L)
Entity Type:Individual
Prefix:MR
First Name:SUSHMIT
Middle Name:
Last Name:MAZUMDAR
Suffix:
Gender:M
Credentials:MBA,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 PONDEROSA CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4149
Mailing Address - Country:US
Mailing Address - Phone:402-219-3235
Mailing Address - Fax:
Practice Address - Street 1:4405 NORMAL BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5551
Practice Address - Country:US
Practice Address - Phone:402-488-2355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE583225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist