Provider Demographics
NPI:1558757963
Name:BAHE, JACEY R
Entity type:Individual
Prefix:MS
First Name:JACEY
Middle Name:R
Last Name:BAHE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JACEY
Other - Middle Name:R
Other - Last Name:KLAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12565 W CENTER RD
Mailing Address - Street 2:SUITE100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3802
Mailing Address - Country:US
Mailing Address - Phone:402-342-5566
Mailing Address - Fax:402-342-0034
Practice Address - Street 1:12565 W CENTER RD
Practice Address - Street 2:SUITE100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3802
Practice Address - Country:US
Practice Address - Phone:402-342-5566
Practice Address - Fax:402-342-0034
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist