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NPI Code Detail

MEDICARE: SUSAN IRENE WEST OT

MEDICARE: SUSAN IRENE WEST OT
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
1225X00000XOccupational Therapist689NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
269854OTHERNEBCBS OF NE

General Provider Information

NPI Number : 1083656680
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN IRENE WEST OT
Provider Business Mailing Address
First Line : 407 BLACK HILLS AVE
Second Line :
City : ALLIANCE
State : NE
Zip : 69301-3243
Country : US
Telephone Number : 308-762-6564
Fax Number : 308-762-3747
Provider Business Practice Location Address
First Line : 407 BLACK HILLS AVE
Second Line :
City : ALLIANCE
State : NE
Zip : 69301-3243
Country : US
Telephone Number : 308-762-6564
Fax Number : 308-762-3747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2006
Last Update Date : 02/26/2010

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