MEDICARE: MRS. AMY J KLOESS MOTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	954	NE

General Provider Information

NPI Number	:	1306114962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY J KLOESS MOTR/L

Provider Business Mailing Address
First Line	:	8165 N TWIN LAKES RD
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101
Country	:	US
Telephone Number	:	304-534-7494
Fax Number	:

Provider Business Practice Location Address
First Line	:	8165 NORTH TWIN LAKES RD
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101
Country	:	US
Telephone Number	:	304-534-7494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	12/09/2011

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