=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770890709
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE A CORDRAY MOT, OTR/L, CLT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2010
-----------------------------------------------------
Last Update Date | 05/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 207 S BURLINGTON AVE
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68901-5905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-462-8824
-----------------------------------------------------
Fax | 402-462-8017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2219 W 7TH ST
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68901-4212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-990-4597
-----------------------------------------------------
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 | 1433
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------