Healthcare Provider Details

I. General information

NPI: 1669123196
Provider Name (Legal Business Name): COUNTY OF OTOE SCHOOL DISTRICT 111
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 14TH AVE
NEBRASKA CITY NE
68410-1146
US

IV. Provider business mailing address

1700 14TH AVE
NEBRASKA CITY NE
68410-1146
US

V. Phone/Fax

Practice location:
  • Phone: 402-873-6033
  • Fax:
Mailing address:
  • Phone: 402-873-6033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JASON HIPPEN
Title or Position: DIRECTOR OF STUDENT SERVICES
Credential:
Phone: 402-873-6033