MEDICARE: RYAN MICHAEL ROBERTS

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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1306646583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MICHAEL ROBERTS

Provider Business Mailing Address
First Line	:	305 N 4TH ST
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-4003
Country	:	US
Telephone Number	:	402-371-1147
Fax Number	:	402-371-1218

Provider Business Practice Location Address
First Line	:	1009 N 10TH ST
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2720
Country	:	US
Telephone Number	:	402-371-1147
Fax Number	:

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

Provider Enumeration Date	:	03/17/2025
Last Update Date	:	03/17/2025

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