Healthcare Provider Details

I. General information

NPI: 1952699829
Provider Name (Legal Business Name): RAEGAN KIMBERLY HAIN M.S., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 05/09/2017
Certification Date:
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

935 N 11TH ST
SEWARD NE
68434-1401
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-0344
  • Fax:
Mailing address:
  • Phone: 530-330-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1573
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: