Healthcare Provider Details

I. General information

NPI: 1871767988
Provider Name (Legal Business Name): SHANNON RENAE RUZICKA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 01/09/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 TALL GRASS CIR
BENNET NE
68317-2411
US

IV. Provider business mailing address

50 TALL GRASS CIR
BENNET NE
68317-2411
US

V. Phone/Fax

Practice location:
  • Phone: 402-310-9505
  • Fax:
Mailing address:
  • Phone: 402-310-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1246
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: