Healthcare Provider Details

I. General information

NPI: 1629549860
Provider Name (Legal Business Name): MARCIE A ROSE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARCIE A MINCHOW OT

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 CENTER PARK RD STE 2
LINCOLN NE
68512-1227
US

IV. Provider business mailing address

404 W F ST
NORTH PLATTE NE
69101-5231
US

V. Phone/Fax

Practice location:
  • Phone: 402-261-0235
  • Fax: 402-261-0428
Mailing address:
  • Phone: 308-660-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1803
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: