Healthcare Provider Details

I. General information

NPI: 1083488365
Provider Name (Legal Business Name): SOUTHERN PUBLIC SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S 11TH ST
WYMORE NE
68466-1615
US

IV. Provider business mailing address

PO BOX 237
WYMORE NE
68466-0237
US

V. Phone/Fax

Practice location:
  • Phone: 402-645-3326
  • Fax:
Mailing address:
  • Phone: 402-645-3326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER PROSOSKI
Title or Position: SUPERINTENDENT
Credential:
Phone: 402-645-3326