Healthcare Provider Details

I. General information

NPI: 1023672938
Provider Name (Legal Business Name): ANDREW PATRICK FLAHERTY OTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 W US HIGHWAY 34
GRAND ISLAND NE
68801-8823
US

IV. Provider business mailing address

1005 W CHARLES ST
GRAND ISLAND NE
68801-6441
US

V. Phone/Fax

Practice location:
  • Phone: 402-917-5400
  • Fax: 308-382-0125
Mailing address:
  • Phone: 402-917-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number884
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: