Provider Demographics
NPI:1124342985
Name:MEINECKE, SALLY SUE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:SUE
Last Name:MEINECKE
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 1:1005 FARNUM ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-1913
Mailing Address - Country:US
Mailing Address - Phone:308-381-8299
Mailing Address - Fax:
Practice Address - Street 1:1005 FARNUM ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:NE
Practice Address - Zip Code:68873-1913
Practice Address - Country:US
Practice Address - Phone:308-381-8299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE884225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist