Healthcare Provider Details

I. General information

NPI: 1659858371
Provider Name (Legal Business Name): ALIDA DRAAYER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 CIMARRON PLZ STE 105
HASTINGS NE
68901-2883
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-2077
  • Fax: 402-463-2062
Mailing address:
  • Phone: 308-382-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2224
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: