Healthcare Provider Details

I. General information

NPI: 1194153759
Provider Name (Legal Business Name): KIMBERLY BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S 18TH ST
PLATTSMOUTH NE
68048-2056
US

IV. Provider business mailing address

14808 ERSKINE ST
OMAHA NE
68116-5123
US

V. Phone/Fax

Practice location:
  • Phone: 402-296-2800
  • Fax:
Mailing address:
  • Phone: 402-884-7690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1745
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: