Provider Demographics
NPI:1528692241
Name:ZAGOZDA, HUONG (OT)
Entity type:Individual
Prefix:
First Name:HUONG
Middle Name:
Last Name:ZAGOZDA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:HUONG
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2725 S 144TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5253
Mailing Address - Country:US
Mailing Address - Phone:402-637-0800
Mailing Address - Fax:402-637-0808
Practice Address - Street 1:2725 S 144TH ST STE 212
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5253
Practice Address - Country:US
Practice Address - Phone:402-637-0800
Practice Address - Fax:402-637-0808
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114886225X00000X
NE2368225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE50615242301Medicaid