Healthcare Provider Details

I. General information

NPI: 1306395470
Provider Name (Legal Business Name): MARISSA E HORAK OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S 68TH STREET PL STE 200
LINCOLN NE
68510-2496
US

IV. Provider business mailing address

201 S 68TH STREET PL STE 200
LINCOLN NE
68510-2496
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-7000
  • Fax: 402-420-6969
Mailing address:
  • Phone: 402-420-7000
  • Fax: 402-420-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2035
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: