Provider Demographics
NPI:1740949593
Name:LO, MINWEN (OTR/L)
Entity type:Individual
Prefix:
First Name:MINWEN
Middle Name:
Last Name:LO
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 1:15505 RUGGLES ST STE 109
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-8832
Mailing Address - Country:US
Mailing Address - Phone:531-466-3121
Mailing Address - Fax:531-999-3879
Practice Address - Street 1:15505 RUGGLES ST STE 109
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-8832
Practice Address - Country:US
Practice Address - Phone:531-466-3121
Practice Address - Fax:531-999-3879
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2235225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics