Healthcare Provider Details

I. General information

NPI: 1508736935
Provider Name (Legal Business Name): PAIGE C KOTIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 E 23RD ST
FREMONT NE
68025-2448
US

IV. Provider business mailing address

1202 E 14TH ST
WAYNE NE
68787-1247
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-7000
  • Fax:
Mailing address:
  • Phone: 402-375-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: