1205226552 NPI number — MS. BONNILEE ANNE TYRRELL OCCUPATIONAL THERAPY

Table of content: MS. BONNILEE ANNE TYRRELL OCCUPATIONAL THERAPY (NPI 1205226552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205226552 NPI number — MS. BONNILEE ANNE TYRRELL OCCUPATIONAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYRRELL
Provider First Name:
BONNILEE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OCCUPATIONAL THERAPY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TYRRELL
Provider Other First Name:
BONNIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205226552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1710 NORTH 70TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68505-1505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-761-3230
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7208 VAN DORN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68506-3651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-499-7713
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  809 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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