Provider Demographics
NPI:1194493676
Name:PROCHASKA, JADE MICHELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:MICHELLE
Last Name:PROCHASKA
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 1:13168 V RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NE
Mailing Address - Zip Code:68662-5606
Mailing Address - Country:US
Mailing Address - Phone:402-367-9719
Mailing Address - Fax:
Practice Address - Street 1:1400 MARK DR
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-4023
Practice Address - Country:US
Practice Address - Phone:402-443-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2598225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist