Healthcare Provider Details

I. General information

NPI: 1154873115
Provider Name (Legal Business Name): BRITTNEY WOODWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S TABOR AVE
NORTH PLATTE NE
69101-7641
US

IV. Provider business mailing address

1301 S TABOR AVE
NORTH PLATTE NE
69101-7641
US

V. Phone/Fax

Practice location:
  • Phone: 308-539-4070
  • Fax:
Mailing address:
  • Phone: 308-539-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number2048
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: