Healthcare Provider Details

I. General information

NPI: 1760099014
Provider Name (Legal Business Name): REBECCA ANN OHLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 SW KELSEY CIR
LINCOLN NE
68522-4446
US

IV. Provider business mailing address

1235 SW KELSEY CIR
LINCOLN NE
68522-4446
US

V. Phone/Fax

Practice location:
  • Phone: 402-310-7583
  • Fax:
Mailing address:
  • Phone: 402-310-7583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number310
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1432
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: