Healthcare Provider Details

I. General information

NPI: 1114863354
Provider Name (Legal Business Name): ANTOINETTE BRIELLE CAVE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12165 W CENTER RD STE 73
OMAHA NE
68144-3974
US

IV. Provider business mailing address

12165 W CENTER RD STE 73
OMAHA NE
68144-3974
US

V. Phone/Fax

Practice location:
  • Phone: 402-275-2112
  • Fax:
Mailing address:
  • Phone: 402-275-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014599
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: