MEDICARE: MRS. SALLY SUE MEINECKE OTR/L

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
1	225X00000X	Occupational Therapist	884	NE

General Provider Information

NPI Number	:	1124342985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLY SUE MEINECKE OTR/L

Provider Business Mailing Address
First Line	:	1005 FARNUM ST
Second Line	:
City	:	SAINT PAUL
State	:	NE
Zip	:	68873-1913
Country	:	US
Telephone Number	:	308-381-8299
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 FARNUM ST
Second Line	:
City	:	SAINT PAUL
State	:	NE
Zip	:	68873-1913
Country	:	US
Telephone Number	:	308-381-8299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2010
Last Update Date	:	03/23/2010

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