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NPI Code Detail

MEDICARE: FULLY ALIVE OCCUPATIONAL THERAPY

MEDICARE: FULLY ALIVE OCCUPATIONAL THERAPY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11629549860OTHERNENPPES

General Provider Information

NPI Number : 1003388802
Entity Type Code : Organization
Provider Name (Legal Business Name) : FULLY ALIVE OCCUPATIONAL THERAPY
Provider Business Mailing Address
First Line : 404 W F ST
Second Line :
City : NORTH PLATTE
State : NE
Zip : 69101-5231
Country : US
Telephone Number : 308-660-7867
Fax Number :
Provider Business Practice Location Address
First Line : 1002 E PHILIP AVE
Second Line :
City : NORTH PLATTE
State : NE
Zip : 69101-6104
Country : US
Telephone Number : 308-532-4940
Fax Number :
Authorized Official
Title or Position : OCCUPATIONAL THERAPY
Name : MARCIE MINCHOW
Credential : OT
Telephone Number : 308-660-7867
Provider Enumeration Date : 12/18/2018
Last Update Date : 12/18/2018

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1558750570 — MATTHEW FOSKET MA, LIMHP, NCC
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1629549860 — MISS MARCIE A MINCHOW OT
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Directions to “FULLY ALIVE OCCUPATIONAL THERAPY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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