MEDICARE: MRS. ABBY HANSON MATHIS 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	1688	NE

General Provider Information

NPI Number	:	1659613214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ABBY HANSON MATHIS OTR/L

Provider Business Mailing Address
First Line	:	823 N 4TH ST
Second Line	:
City	:	NEBRASKA CITY
State	:	NE
Zip	:	68410-1401
Country	:	US
Telephone Number	:	641-512-6134
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 14TH AVE
Second Line	:
City	:	NEBRASKA CITY
State	:	NE
Zip	:	68410-1159
Country	:	US
Telephone Number	:	402-873-6650
Fax Number	:

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

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	03/21/2013

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