Provider Demographics
NPI:1639355647
Name:MONGEON, RACHEL MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MARIE
Last Name:MONGEON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-3700
Mailing Address - Country:US
Mailing Address - Phone:402-483-4300
Mailing Address - Fax:402-483-7789
Practice Address - Street 1:2855 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3700
Practice Address - Country:US
Practice Address - Phone:402-483-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102768225X00000X
NE1482225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025862100Medicaid