Provider Demographics
NPI:1124448360
Name:DABERKOW, MORGAN (COTA/L)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:DABERKOW
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85155 513TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:NE
Mailing Address - Zip Code:68726-5274
Mailing Address - Country:US
Mailing Address - Phone:402-307-0258
Mailing Address - Fax:
Practice Address - Street 1:1100 T ST
Practice Address - Street 2:
Practice Address - City:NELIGH
Practice Address - State:NE
Practice Address - Zip Code:68756-1027
Practice Address - Country:US
Practice Address - Phone:402-887-5428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE992310400000X, 311500000X, 313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility