Healthcare Provider Details

I. General information

NPI: 1992636591
Provider Name (Legal Business Name): MICHAEL GUDERJAN OTD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 RANDOLPH ST
LINCOLN NE
68510-3741
US

IV. Provider business mailing address

4720 RANDOLPH ST
LINCOLN NE
68510-3741
US

V. Phone/Fax

Practice location:
  • Phone: 402-310-3140
  • Fax:
Mailing address:
  • Phone: 402-310-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1912
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: