Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2118 | NE |
NPI | 1003395245 |
---|---|
Provider Name | Mr. Matthew Douglas Buescher |
First Address | Lincoln, NE 68506-3567 |
Second Address | Lincoln, NE 68502-2251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2018 |
Last Update Date | 08/08/2018 |