Healthcare Provider Details

I. General information

NPI: 1316908973
Provider Name (Legal Business Name): DELTON FRIESEN OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DELTON FRIESEN

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N DIERS AVE STE 300
GRAND ISLAND NE
68803-4985
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-0344
  • Fax: 308-382-3241
Mailing address:
  • Phone: 308-675-1853
  • Fax: 308-210-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number353
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: