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General NPI Number Information
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NPI Number | 1689307332
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Entity Type | Individual
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Provider Name | LEXIE MARIE EDSTROM OT
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Gender | Female
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 3601 CIMARRON PLZ STE 105
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City | HASTINGS
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State | NE
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Zip | 68901-2883
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Country | US
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Telephone | 402-463-2077
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Fax | 402-463-2062
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Provider Business Mailing Address
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Address Line | PO BOX 404
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City | ELWOOD
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State | NE
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Zip | 68937-0404
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Country | US
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Telephone | 308-325-7957
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2667
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License Number State | NE
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