Healthcare Provider Details

I. General information

NPI: 1508201294
Provider Name (Legal Business Name): STEPHANIE MARIE OELKE MOT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 U ST
AUBURN NE
68305-3215
US

IV. Provider business mailing address

320 LOCUST ST
SYRACUSE NE
68446-9690
US

V. Phone/Fax

Practice location:
  • Phone: 402-274-4954
  • Fax:
Mailing address:
  • Phone: 402-269-5899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1665
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: