Provider Demographics
NPI:1356070932
Name:LUM, ANDREW RYAN (OTD, MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RYAN
Last Name:LUM
Suffix:
Gender:M
Credentials:OTD, MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2150
Mailing Address - Country:US
Mailing Address - Phone:402-413-3900
Mailing Address - Fax:
Practice Address - Street 1:17500 BURKE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2244
Practice Address - Country:US
Practice Address - Phone:402-401-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2643225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist