Provider Demographics
NPI:1578370896
Name:BOHLKEN, STACY (OTR/L)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BOHLKEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 S 89TH ST APT 2332
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-6525
Mailing Address - Country:US
Mailing Address - Phone:402-615-5816
Mailing Address - Fax:
Practice Address - Street 1:2404 DENVER ST
Practice Address - Street 2:
Practice Address - City:SCHUYLER
Practice Address - State:NE
Practice Address - Zip Code:68661-1187
Practice Address - Country:US
Practice Address - Phone:402-352-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2975225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist