Healthcare Provider Details

I. General information

NPI: 1811888902
Provider Name (Legal Business Name): MIKAELA WINTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W 38TH ST
SCOTTSBLUFF NE
69361-4616
US

IV. Provider business mailing address

211 W 38TH ST
SCOTTSBLUFF NE
69361-4616
US

V. Phone/Fax

Practice location:
  • Phone: 308-225-1870
  • Fax: 888-908-5481
Mailing address:
  • Phone: 308-225-1870
  • Fax: 888-908-5481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2337
License Number StateNE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: