Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports |
NPI | 1528667540 |
---|---|
Provider Name | Zoe Otteman |
First Address | Gretna, NE 68028-7853 |
Second Address | Gretna, NE 68028-7853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2020 |
Last Update Date | 21/10/2020 |