Basic Information
| Provider Information | |||||||||
| NPI: | 1528667540 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OTTEMAN | ||||||||
| FirstName: | ZOE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 913 VILLAGE SQ | ||||||||
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| City: | GRETNA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680287853 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 913 VILLAGE SQ | ||||||||
| Address2: | |||||||||
| City: | GRETNA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680287853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029320747 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2020 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251S0007X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
No ID Information.