=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508201294
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE MARIE OELKE MOT OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2013
-----------------------------------------------------
Last Update Date | 05/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1322 U ST
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68305-3215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-274-4954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 LOCUST ST
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68446-9690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-269-5899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 1665
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------