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NPI 1205425063

NPI 1205425063 : EMPOWERME ASL, LLC : LA VISTA, NE

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General NPI Number Information
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    NPI Number           |    1205425063
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    Entity Type          |    Organization 
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    Legal Business Name  |    EMPOWERME ASL, LLC 
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Dates
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    Enumeration Date     |    01/14/2021
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    Last Update Date     |    10/01/2025
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Provider Practice Location Address
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    Address Line         |    8140 S 97TH PLZ 
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    City                 |    LA VISTA
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    State                |    NE
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    Zip                  |    68128-7104
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    Country              |    US
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    Telephone            |    844-502-7996
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    1335 STRASSNER DR 
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    City                 |    BRENTWOOD
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    State                |    MO
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    Zip                  |    63144-1872
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    Country              |    US
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    Telephone            |    844-502-7996
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    Fax                  |    
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Authorized Official
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    Title or Position    |    VP OF FINANCE
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    Name                 |     JOHN DAVID CHURCH 
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    Credential           |    
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    Telephone            |    844-502-9996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    235Z00000X
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    Taxonomy Name        |    Speech-Language Pathologist
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    License Number       |    
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    License Number State |    
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Taxonomy #2
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    Taxonomy Code        |    225XG0600X
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    Taxonomy Name        |    Gerontology Occupational Therapist
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    License Number       |    
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    License Number State |    
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Taxonomy #3
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    Taxonomy Code        |    225X00000X
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    Taxonomy Name        |    Occupational Therapist
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    License Number       |    
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    License Number State |    
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Taxonomy #4
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    Taxonomy Code        |    225100000X
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    Taxonomy Name        |    Physical Therapist
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    License Number       |    
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    License Number State |    
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Taxonomy #5
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    Taxonomy Code        |    2251G0304X
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    Taxonomy Name        |    Geriatric Physical Therapist
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    License Number       |    
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    License Number State |    
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Taxonomy #6
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    Taxonomy Code        |    261QM1300X
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    Taxonomy Name        |    Multi-Specialty Clinic/Center
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    License Number       |    
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    License Number State |    
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