Healthcare Provider Details

I. General information

NPI: 1487078259
Provider Name (Legal Business Name): CHRISTINA BUEIDE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 LODGE DR
GERING NE
69341-6825
US

IV. Provider business mailing address

1930 Q ST
GERING NE
69341-2313
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-5965
  • Fax:
Mailing address:
  • Phone: 308-672-5079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number242
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: