Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 001817 | IA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1060 | NE |
NPI | 1306124326 |
---|---|
Provider Name | Julie A Hildebrandt |
First Address | Omaha, NE 68124-2118 |
Second Address | Omaha, NE 68124-2118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2011 |
Last Update Date | 25/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000798 | (05) | IA |
1060 | (05) | NE |