Provider Demographics
NPI:1134338205
Name:LIST, TANYA LEE (OTD, OTRL)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LEE
Last Name:LIST
Suffix:
Gender:F
Credentials:OTD, OTRL
Other - Prefix:MRS
Other - First Name:TANYA
Other - Middle Name:LEE
Other - Last Name:ZINNEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTRL
Mailing Address - Street 1:11753 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-2223
Mailing Address - Country:US
Mailing Address - Phone:402-630-2874
Mailing Address - Fax:
Practice Address - Street 1:11753 FOWLER AVENUE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164
Practice Address - Country:US
Practice Address - Phone:402-630-2874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1230225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist