Healthcare Provider Details

I. General information

NPI: 1558184390
Provider Name (Legal Business Name): ANDREA NICOLE ZYLA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA NICOLE WOLF OTR/L

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 FORT CROOK RD N STE 202
BELLEVUE NE
68005-4226
US

IV. Provider business mailing address

10909 MILL VALLEY RD STE 210
OMAHA NE
68154-3950
US

V. Phone/Fax

Practice location:
  • Phone: 402-763-4408
  • Fax: 402-343-1278
Mailing address:
  • Phone: 402-391-5002
  • Fax: 402-343-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2968
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: