Healthcare Provider Details

I. General information

NPI: 1578439667
Provider Name (Legal Business Name): TAYLOR CAMILLE FISHER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 S LOCUST ST
GRAND ISLAND NE
68801-6751
US

IV. Provider business mailing address

929 S LOCUST ST
GRAND ISLAND NE
68801-6751
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-9700
  • Fax: 308-382-9898
Mailing address:
  • Phone: 308-382-9700
  • Fax: 308-382-9898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3032
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: