Basic Information
Provider Information
NPI: 1588336713
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KOEPPING
FirstName: ASHLEY
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3925 S 147TH ST STE 109-111
Address2:  
City: OMAHA
State: NE
PostalCode: 681445565
CountryCode: US
TelephoneNumber: 4029421329
FaxNumber: 4026064664
Practice Location
Address1: 913 VILLAGE SQ
Address2:  
City: GRETNA
State: NE
PostalCode: 680287853
CountryCode: US
TelephoneNumber: 4029320747
FaxNumber: 4029915685
Other Information
ProviderEnumerationDate: 10/05/2021
LastUpdateDate: 02/01/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/01/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X2479NEY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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